Provider Demographics
NPI:1336191121
Name:OLIVAREZ, LORI M (APRN)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:M
Last Name:OLIVAREZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:BARNHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:7807 BAYMEADOWS RD E.
Mailing Address - Street 2:SUITE 207
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256
Mailing Address - Country:US
Mailing Address - Phone:904-446-9991
Mailing Address - Fax:904-446-9992
Practice Address - Street 1:7807 BAYMEADOWS RD E.
Practice Address - Street 2:SUITE 207
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256
Practice Address - Country:US
Practice Address - Phone:904-446-9991
Practice Address - Fax:904-446-9992
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9162300363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306934600Medicaid