Healthcare Provider Details

I. General information

NPI: 1548509698
Provider Name (Legal Business Name): ANALISA PINO OLMOGUEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANALISA BOOC PINO RN

II. Dates (important events)

Enumeration Date: 02/09/2013
Last Update Date: 02/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

11313 PANTHER CREEK PKWY
JACKSONVILLE FL
32221-1039
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-0000
  • Fax:
Mailing address:
  • Phone: 904-422-6514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9230245
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: