Healthcare Provider Details

I. General information

NPI: 1831773779
Provider Name (Legal Business Name): LAUREN MARIE OLSEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6271 SAINT AUGUSTINE RD STE 1
JACKSONVILLE FL
32217-2555
US

IV. Provider business mailing address

PO BOX 44008
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-633-0460
  • Fax:
Mailing address:
  • Phone: 904-633-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS21308
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: