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General NPI Number Information
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NPI Number | 1144317876
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Entity Type | Individual
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Provider Name | MARTHA ANN OLSON P.A.
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Gender | Female
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 04/13/2020
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Provider Practice Location Address
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Address Line | 701 MEDICAL PLAZA DR
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City | LEESBURG
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State | FL
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Zip | 34748-7313
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Country | US
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Telephone | 352-326-8115
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Fax | 352-326-5282
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Provider Business Mailing Address
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Address Line | 10 CLARK ST
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City | ENTERPRISE
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State | FL
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Zip | 32725-8106
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Country | US
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Telephone | 386-507-5269
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Fax | 855-879-6592
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PAT9103766
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA9103766
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License Number State | FL
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