MEDICARE: MRS. OLANDA MARIE HATHAWAY 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	363L00000X	Nurse Practitioner	APRN11038526	FL
2	363LF0000X	Family Nurse Practitioner	RN042630	LA
3	363LF0000X	Family Nurse Practitioner	R109289	MD
4	363LF0000X	Family Nurse Practitioner	APRN11038526	FL

General Provider Information

NPI Number	:	1962496471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OLANDA MARIE HATHAWAY APRN

Provider Business Mailing Address
First Line	:	PO BOX 23168
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-0001
Country	:	US
Telephone Number	:	301-802-5114
Fax Number	:

Provider Business Practice Location Address
First Line	:	13770 PLANTATION RD # 103
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4460
Country	:	US
Telephone Number	:	941-444-0011
Fax Number	:	603-952-3900

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/11/2025

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