Provider Demographics
NPI:1669827572
Name:CARRASQUILLO, OLIVIA (NP)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:CARRASQUILLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PRESIDENTIAL BLVD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1107
Mailing Address - Country:US
Mailing Address - Phone:610-664-9700
Mailing Address - Fax:
Practice Address - Street 1:3998 RED LION ROAD
Practice Address - Street 2:SUITE 240
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114
Practice Address - Country:US
Practice Address - Phone:215-632-3500
Practice Address - Fax:215-632-6335
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP015904363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology