Healthcare Provider Details

I. General information

NPI: 1134943525
Provider Name (Legal Business Name): CALIE OCIESA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CALIE MCVAY

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 12/20/2024
Certification Date: 12/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 LIBERTY LN
WESTLAKE FL
33470-2007
US

IV. Provider business mailing address

5205 LIBERTY LN
WESTLAKE FL
33470-2007
US

V. Phone/Fax

Practice location:
  • Phone: 954-540-7053
  • Fax:
Mailing address:
  • Phone: 954-540-7053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2024060759
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: