Healthcare Provider Details

I. General information

NPI: 1275389371
Provider Name (Legal Business Name): MARIA ELIZABETH OLVERA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21298 OLEAN BLVD
PORT CHARLOTTE FL
33952-6705
US

IV. Provider business mailing address

21298 OLEAN BLVD
PORT CHARLOTTE FL
33952-6705
US

V. Phone/Fax

Practice location:
  • Phone: 863-444-2916
  • Fax:
Mailing address:
  • Phone: 941-629-1181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11029004
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: