Healthcare Provider Details

I. General information

NPI: 1093308363
Provider Name (Legal Business Name): OLIVIER BELIZAIRE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20257 ROYAL VILLAGIO CT UNIT 107
ESTERO FL
33928-3166
US

IV. Provider business mailing address

20257 ROYAL VILLAGIO CT UNIT 107
ESTERO FL
33928-3166
US

V. Phone/Fax

Practice location:
  • Phone: 561-396-3145
  • Fax:
Mailing address:
  • Phone: 561-396-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9400564
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11013447
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9681274
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024193615
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7773
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: