MEDICARE: GLADYS MARIAM OLIVERA PMHNP

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	11033181	FL

General Provider Information

NPI Number	:	1275374878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLADYS MARIAM OLIVERA PMHNP

Provider Business Mailing Address
First Line	:	1333 W 37TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4858
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 W 37TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-4858
Country	:	US
Telephone Number	:	786-838-7635
Fax Number	:

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

Provider Enumeration Date	:	06/05/2024
Last Update Date	:	03/25/2025

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