Provider Demographics
NPI:1508488503
Name:OLIVERA, GIRALDO (APRN)
Entity type:Individual
Prefix:
First Name:GIRALDO
Middle Name:
Last Name:OLIVERA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 HOWARD ST E
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32064-3401
Mailing Address - Country:US
Mailing Address - Phone:386-320-6900
Mailing Address - Fax:386-901-4001
Practice Address - Street 1:601 HOWARD ST E
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32064-3401
Practice Address - Country:US
Practice Address - Phone:386-320-6900
Practice Address - Fax:386-901-4001
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-12
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily