MEDICARE: JEFFREY D. OLSON

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	390200000X	Student in an Organized Health Care Education/Training Program		FL

General Provider Information

NPI Number	:	1487024055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY D. OLSON

Provider Business Mailing Address
First Line	:	2800 HILLVIEW ST
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-3221
Country	:	US
Telephone Number	:	941-316-0406
Fax Number	:	941-316-9317

Provider Business Practice Location Address
First Line	:	2800 HILLVIEW ST
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-3221
Country	:	US
Telephone Number	:	941-316-0406
Fax Number	:	941-316-9317

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

Provider Enumeration Date	:	09/25/2015
Last Update Date	:	09/25/2015

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