Provider Demographics
NPI:1558663625
Name:BAMISHIGBIN, OLIVIA O (NP-C, FNP-BC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:O
Last Name:BAMISHIGBIN
Suffix:
Gender:F
Credentials:NP-C, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 PENN ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2694
Mailing Address - Country:US
Mailing Address - Phone:305-430-9906
Mailing Address - Fax:305-430-9906
Practice Address - Street 1:1801 PENN ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2694
Practice Address - Country:US
Practice Address - Phone:305-430-9906
Practice Address - Fax:305-430-9906
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9228650363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily