Provider Demographics
NPI:1053870022
Name:OLIVA, PATRICIA (PA-C)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:OLIVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 TOMAHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8092
Mailing Address - Country:US
Mailing Address - Phone:813-245-7284
Mailing Address - Fax:
Practice Address - Street 1:1162 CYPRESS GLEN CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7560
Practice Address - Country:US
Practice Address - Phone:407-343-9006
Practice Address - Fax:407-343-0999
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111857363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical