Healthcare Provider Details

I. General information

NPI: 1356873863
Provider Name (Legal Business Name): JENNIFER OLSON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 01/31/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 NW 6TH ST
GAINESVILLE FL
32601-4020
US

IV. Provider business mailing address

5327 NW 23RD PL
GAINESVILLE FL
32606-6432
US

V. Phone/Fax

Practice location:
  • Phone: 772-463-0444
  • Fax: 772-219-1339
Mailing address:
  • Phone: 321-424-4486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number17-30810
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: