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General NPI Number Information
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NPI Number | 1689442774
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Entity Type | Individual
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Provider Name | MARIELA OLMEDO FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 2115 S BROADWAY AVE
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City | TYLER
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State | TX
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Zip | 75701-4214
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Country | US
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Telephone | 903-907-7002
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Fax | 903-408-6592
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Provider Business Mailing Address
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Address Line | PO BOX 746079
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City | ATLANTA
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State | GA
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Zip | 30374-6079
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Country | US
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Telephone | 773-352-1515
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Fax | 312-929-0373
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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 | 0024191232
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License Number State | VA
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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 | F08230579
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License Number State | TX
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