MEDICARE: NANGE OLIVACCE NP

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	339500	AZ
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	307177	GA

General Provider Information

NPI Number	:	1467382580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANGE OLIVACCE NP

Provider Business Mailing Address
First Line	:	1270 SPRING ST NW UNIT 209
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-2895
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2404 N STOCKTON HILL RD STE A
Second Line	:
City	:	KINGMAN
State	:	AZ
Zip	:	86401-4184
Country	:	US
Telephone Number	:	800-662-4357
Fax Number	:

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

Provider Enumeration Date	:	05/20/2026
Last Update Date	:	06/01/2026

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