Healthcare Provider Details

I. General information

NPI: 1750628046
Provider Name (Legal Business Name): JENNIFER LYNNE OLIVAREZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LYNNE OLIVAREZ PA

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 82ND PKWY
MYRTLE BEACH SC
29572-4607
US

IV. Provider business mailing address

809 82ND PARKWAY GME OFFICE
MYRTLE BEACH SC
29572
US

V. Phone/Fax

Practice location:
  • Phone: 184-369-2100
  • Fax:
Mailing address:
  • Phone: 843-692-1752
  • Fax: 843-692-1904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberV3929
License Number StateTX

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: