Provider Demographics
NPI:1164076212
Name:OLIN, TERI
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:OLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 WORLEY STREET
Mailing Address - Street 2:
Mailing Address - City:CHOKOLOSKEE
Mailing Address - State:FL
Mailing Address - Zip Code:34138
Mailing Address - Country:US
Mailing Address - Phone:352-219-8206
Mailing Address - Fax:
Practice Address - Street 1:1645 PALM BEACH LAKES BLVD STE 240
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2205
Practice Address - Country:US
Practice Address - Phone:863-604-1820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-26
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2147692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily