MEDICARE: OLIVIA HERMAN RN

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	RN9432113	FL

General Provider Information

NPI Number	:	1790319309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA HERMAN RN

Provider Business Mailing Address
First Line	:	146 PALM COAST RESORT BLVD UNIT 406
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-1828
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	146 PALM COAST RESORT BLVD UNIT 406
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-1828
Country	:	US
Telephone Number	:	586-201-8774
Fax Number	:

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

Provider Enumeration Date	:	02/24/2020
Last Update Date	:	02/24/2020

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