Healthcare Provider Details

I. General information

NPI: 1427844869
Provider Name (Legal Business Name): OLIVE BRANCH MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 SE 1ST AVE STE 200
OCALA FL
34471-2177
US

IV. Provider business mailing address

35 SE 1ST AVE STE 200F
OCALA FL
34471-2177
US

V. Phone/Fax

Practice location:
  • Phone: 352-234-3334
  • Fax:
Mailing address:
  • Phone: 352-234-3334
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JULIE CRUSE
Title or Position: MANAGING PARTNER
Credential: APRN
Phone: 352-234-3332