Provider Demographics
NPI:1407617319
Name:GRACEFUL OLIVES HEALTH
Entity Type:Organization
Organization Name:GRACEFUL OLIVES HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:UGOCHI
Authorized Official - Middle Name:NWANYIETODI
Authorized Official - Last Name:NWAOBI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:352-286-9347
Mailing Address - Street 1:8403 PINES BLVD # 1440
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6609
Mailing Address - Country:US
Mailing Address - Phone:954-710-9062
Mailing Address - Fax:954-405-8681
Practice Address - Street 1:5742 W HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:WEST PARK
Practice Address - State:FL
Practice Address - Zip Code:33023-5272
Practice Address - Country:US
Practice Address - Phone:954-710-9062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty