MEDICARE: MRS. OLGINE LOUIS DORT APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11038288	FL
2	163W00000X	Registered Nurse	9481632	FL

General Provider Information

NPI Number	:	1033886437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OLGINE LOUIS DORT APRN

Provider Business Mailing Address
First Line	:	1356 W GLEN OAK RD
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-3950
Country	:	US
Telephone Number	:	561-808-9248
Fax Number	:

Provider Business Practice Location Address
First Line	:	1356 W GLEN OAK RD
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-3950
Country	:	US
Telephone Number	:	561-808-9248
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2021
Last Update Date	:	10/09/2025

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