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General NPI Number Information
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NPI Number | 1164076212
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Entity Type | Individual
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Provider Name | TERI OLIN
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Gender | Female
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Dates
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Enumeration Date | 07/26/2019
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | 1645 PALM BEACH LAKES BLVD STE 240
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-2205
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Country | US
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Telephone | 863-604-1820
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Fax |
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Provider Business Mailing Address
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Address Line | 274 WORLEY STREET
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City | CHOKOLOSKEE
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State | FL
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Zip | 34138
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Country | US
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Telephone | 352-219-8206
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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 | 2147692
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License Number State | FL
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