Healthcare Provider Details

I. General information

NPI: 1811806839
Provider Name (Legal Business Name): OLIVA RUSSO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OLIVIA ANN WOLAK APRN

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 TAMIAMI TRL S STE A2
VENICE FL
34285-3668
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 941-484-3531
  • Fax: 941-486-1701
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN76664
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: