Provider Demographics
NPI:1467890665
Name:OLLIVIERRE-AGARD, RACHAEL VERONIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:VERONIQUE
Last Name:OLLIVIERRE-AGARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 LEWALLEN CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:SUNBRIGHT
Mailing Address - State:TN
Mailing Address - Zip Code:37872-3353
Mailing Address - Country:US
Mailing Address - Phone:478-718-8329
Mailing Address - Fax:
Practice Address - Street 1:210 N MISSOURI AVE UNIT 809
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-1561
Practice Address - Country:US
Practice Address - Phone:813-754-7756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN65629207Q00000X
WY12159C207Q00000X
AZ59051207Q00000X
WI462-320207Q00000X
IDMC-0233207Q00000X
NV18939207Q00000X
IAMD-46367207Q00000X
ALMD.38356207Q00000X
UT11331233-1205207Q00000X
MDD83101207Q00000X
MEMD23159207Q00000X
TN55551207Q00000X
SD11558207Q00000X
DEC1-0011642207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine