Healthcare Provider Details

I. General information

NPI: 1184681512
Provider Name (Legal Business Name): GARY B OLENICK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 SO OLD DIXIE HWY
JUPITER FL
33458
US

IV. Provider business mailing address

PO BOX 1620
JUPITER FL
33468
US

V. Phone/Fax

Practice location:
  • Phone: 561-649-3138
  • Fax: 561-649-3029
Mailing address:
  • Phone: 561-649-3138
  • Fax: 561-649-3029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9190460
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: