Healthcare Provider Details

I. General information

NPI: 1245061324
Provider Name (Legal Business Name): OLIVIA MENDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

448 SE OSCEOLA ST
STUART FL
34994-2577
US

IV. Provider business mailing address

448 SE OSCEOLA ST
STUART FL
34994-2577
US

V. Phone/Fax

Practice location:
  • Phone: 561-685-6801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11034502
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: