Provider Demographics
NPI:1841165503
Name:BLAKE, OLIVIA (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5383 CASANOVA RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187-8303
Mailing Address - Country:US
Mailing Address - Phone:540-303-3111
Mailing Address - Fax:
Practice Address - Street 1:147 ALEXANDRIA PIKE # 104
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2947
Practice Address - Country:US
Practice Address - Phone:540-952-0285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-10
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024195003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily