Healthcare Provider Details

I. General information

NPI: 1730017963
Provider Name (Legal Business Name): JESSICA ALICE OLSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 ELM ST
NICEVILLE FL
32578-2018
US

IV. Provider business mailing address

1604 OAKMONT CIR
NICEVILLE FL
32578-4344
US

V. Phone/Fax

Practice location:
  • Phone: 850-716-4481
  • Fax:
Mailing address:
  • Phone: 850-716-4481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMM41730
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: