Healthcare Provider Details

I. General information

NPI: 1407617319
Provider Name (Legal Business Name): GRACEFUL OLIVES HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2024
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 THAYER CTR STE C
OAKLAND MD
21550-1139
US

IV. Provider business mailing address

8403 PINES BLVD # 1440
PEMBROKE PINES FL
33024-6609
US

V. Phone/Fax

Practice location:
  • Phone: 315-547-0502
  • Fax: 727-382-0311
Mailing address:
  • Phone: 954-710-9062
  • Fax: 954-405-8681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: UGOCHI NWANYIETODI NWAOBI
Title or Position: OWNER
Credential: PMHNP
Phone: 352-286-9347