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General NPI Number Information
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NPI Number | 1124499801
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Entity Type | Individual
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Provider Name | MARISA OLSEN FNP
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Gender | Female
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 4021 COUNTY ROAD 210 W STE 5
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City | ST JOHNS
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State | FL
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Zip | 32259-1180
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Country | US
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Telephone | 904-747-9802
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Fax |
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Provider Business Mailing Address
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Address Line | 201 SILKGRASS PL
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City | ST JOHNS
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State | FL
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Zip | 32259-7432
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Country | US
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Telephone | 516-606-8800
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11024675
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F338628
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License Number State | NY
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