MEDICARE: OLENKA D VERGARAY

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	163W00000X	Registered Nurse	RN9557222	FL

General Provider Information

NPI Number	:	1154268357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLENKA D VERGARAY

Provider Business Mailing Address
First Line	:	4123 UNIVERSITY BLVD S STE B
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4320
Country	:	US
Telephone Number	:	904-636-9100
Fax Number	:	904-636-9102

Provider Business Practice Location Address
First Line	:	4123 UNIVERSITY BLVD S STE B
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-4320
Country	:	US
Telephone Number	:	904-636-9100
Fax Number	:	904-636-9102

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

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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Directions to “ OLENKA D VERGARAY ” Practice Location

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