Healthcare Provider Details

I. General information

NPI: 1457989287
Provider Name (Legal Business Name): KIRSTEN OLIVIER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 N HABANA AVE STE 203
TAMPA FL
33614-7146
US

IV. Provider business mailing address

4710 N HABANA AVE STE 203
TAMPA FL
33614-7146
US

V. Phone/Fax

Practice location:
  • Phone: 813-995-1775
  • Fax: 813-642-4877
Mailing address:
  • Phone: 813-995-1775
  • Fax: 813-642-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS20655
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0116034115
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: