Healthcare Provider Details

I. General information

NPI: 1063091460
Provider Name (Legal Business Name): GESIE OLISCAT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 SE 1ST AVE
FORT LAUDERDALE FL
33316-2801
US

IV. Provider business mailing address

7844 RED MAHOGANY RD
BOYNTON BEACH FL
33437-7530
US

V. Phone/Fax

Practice location:
  • Phone: 954-523-0106
  • Fax: 954-525-0540
Mailing address:
  • Phone: 561-667-4720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11012376
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: