Provider Demographics
NPI:1184681512
Name:OLENICK, GARY B (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:B
Last Name:OLENICK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1620
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468
Mailing Address - Country:US
Mailing Address - Phone:561-649-3138
Mailing Address - Fax:561-649-3029
Practice Address - Street 1:1210 SO OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-649-3138
Practice Address - Fax:561-649-3029
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9190460367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3174OtherBCBS
FLG3174OtherBCBS