Provider Demographics
NPI:1871236901
Name:JEFFRIES, OLYMPIA NICOLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:OLYMPIA
Middle Name:NICOLE
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13385 WILLOW OAK CIR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-5550
Mailing Address - Country:US
Mailing Address - Phone:228-669-0292
Mailing Address - Fax:
Practice Address - Street 1:13385 WILLOW OAK CIR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-5550
Practice Address - Country:US
Practice Address - Phone:228-669-0292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-17
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906886363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner