Healthcare Provider Details

I. General information

NPI: 1942129887
Provider Name (Legal Business Name): OLIVIA COLBERT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BENMORE DR STE 100
WINTER PARK FL
32792-4111
US

IV. Provider business mailing address

187 SW GETTYSBURG DR
PORT ST LUCIE FL
34953-3191
US

V. Phone/Fax

Practice location:
  • Phone: 407-834-9120
  • Fax:
Mailing address:
  • Phone: 772-380-5342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9122038
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: