MEDICARE: OLIVE HEALTH LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	363A00000X	Physician Assistant
3	363LA2200X	Adult Health Nurse Practitioner
4	363LF0000X	Family Nurse Practitioner
5	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1124612817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLIVE HEALTH LLC

Provider Business Mailing Address
First Line	:	4912 W TRAPNELL RD
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33566-0128
Country	:	US
Telephone Number	:	813-417-4767
Fax Number	:

Provider Business Practice Location Address
First Line	:	4912 W TRAPNELL RD
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33566-0128
Country	:	US
Telephone Number	:	813-417-4767
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. YVETTE GUZMAN
Credential	:	APRN
Telephone Number	:	813-389-9474

Provider Enumeration Date	:	02/24/2021
Last Update Date	:	08/30/2023

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Directions to “OLIVE HEALTH LLC ” Practice Location

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