Provider Demographics
NPI:1659770121
Name:NIMMO-OLSEN, WHITNEY RENAE (ARNP)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:RENAE
Last Name:NIMMO-OLSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:RENAE
Other - Last Name:NIMMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:725 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-9653
Practice Address - Country:US
Practice Address - Phone:904-259-3150
Practice Address - Fax:904-259-7890
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9371287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIA753XOtherMEDICARE
FLIA753WOtherMEDICARE
FL012979200Medicaid
FLY0Q50OtherBCBS