Healthcare Provider Details

I. General information

NPI: 1952805202
Provider Name (Legal Business Name): OLIVIA GAWRYCH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2191 E JOHNSON AVE
PENSACOLA FL
32514-6029
US

IV. Provider business mailing address

600 11TH AVE N APT 464
NASHVILLE TN
37203-4568
US

V. Phone/Fax

Practice location:
  • Phone: 850-494-3917
  • Fax: 850-494-3960
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number65548
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME147070
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: