Healthcare Provider Details

I. General information

NPI: 1447169768
Provider Name (Legal Business Name): OLIVIA WERTHEIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 SAWGRASS CORPORATE PKWY FL 6
SUNRISE FL
33323-2873
US

IV. Provider business mailing address

511 W CLEVELAND ST UNIT 309
TAMPA FL
33606-1986
US

V. Phone/Fax

Practice location:
  • Phone: 800-737-8661
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number224909
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN10030008
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number265081
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: