MEDICARE: OLGA PROSVETOVA APRN

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	363LF0000X	Family Nurse Practitioner	APRN11020714	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568198026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLGA PROSVETOVA APRN

Provider Business Mailing Address
First Line	:	2460 OLD MOULTRIE RD STE 1
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32086-4198
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 MCCORMICK DR
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-2352
Country	:	US
Telephone Number	:	386-246-7365
Fax Number	:

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

Provider Enumeration Date	:	07/27/2022
Last Update Date	:	02/24/2026

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