Provider Demographics
NPI:1053006494
Name:PERDUE, OLIVIA TAYLOR (PA-S)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:TAYLOR
Last Name:PERDUE
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 HEARTLEAF AVE E
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-2774
Mailing Address - Country:US
Mailing Address - Phone:850-381-6997
Mailing Address - Fax:
Practice Address - Street 1:3220 HEARTLEAF AVE E
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-2774
Practice Address - Country:US
Practice Address - Phone:850-381-6997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant