Provider Demographics
NPI:1891170114
Name:OSORIO, JOLENE (FNP)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:OSORIO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S JONES RD
Mailing Address - Street 2:
Mailing Address - City:OLANTA
Mailing Address - State:SC
Mailing Address - Zip Code:29114-9705
Mailing Address - Country:US
Mailing Address - Phone:843-396-9730
Mailing Address - Fax:
Practice Address - Street 1:211 S JONES RD
Practice Address - Street 2:
Practice Address - City:OLANTA
Practice Address - State:SC
Practice Address - Zip Code:29114-9705
Practice Address - Country:US
Practice Address - Phone:843-396-9730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19617363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily