Provider Demographics
NPI:1932500949
Name:PRESAS, OLIVIA (PA-C)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:PRESAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 HIDEAWAY BND
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-7949
Mailing Address - Country:US
Mailing Address - Phone:561-254-9868
Mailing Address - Fax:
Practice Address - Street 1:10140 FOREST HILL BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6125
Practice Address - Country:US
Practice Address - Phone:561-254-9868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102315363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical