Healthcare Provider Details

I. General information

NPI: 1386356509
Provider Name (Legal Business Name): OLIVIA YAEL LEVY DNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA ROSSNAN DNP, APRN

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 UNIVERSITY BLVD S STE 700
JACKSONVILLE FL
32216-7403
US

IV. Provider business mailing address

12745 JOSSLYN LN
JACKSONVILLE FL
32246-2292
US

V. Phone/Fax

Practice location:
  • Phone: 904-399-5678
  • Fax: 904-399-8488
Mailing address:
  • Phone: 561-670-6755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11022548
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number11022548
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: