Healthcare Provider Details

I. General information

NPI: 1861671109
Provider Name (Legal Business Name): PATRICE OLMEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4255 24TH CT
VERO BEACH FL
32967-6251
US

IV. Provider business mailing address

4255 24TH CT
VERO BEACH FL
32967-6251
US

V. Phone/Fax

Practice location:
  • Phone: 772-501-0226
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5149518
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: