Provider Demographics
NPI:1093308363
Name:BELIZAIRE, OLIVIER
Entity Type:Individual
Prefix:
First Name:OLIVIER
Middle Name:
Last Name:BELIZAIRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20257 ROYAL VILLAGIO CT UNIT 107
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3166
Mailing Address - Country:US
Mailing Address - Phone:561-396-3145
Mailing Address - Fax:
Practice Address - Street 1:20257 ROYAL VILLAGIO CT UNIT 107
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3166
Practice Address - Country:US
Practice Address - Phone:561-396-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9400564163WC0200X
FLAPRN11013447367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine