Provider Demographics
NPI:1831925676
Name:MALLOY, OLIVIA (NBC-HWC)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:MALLOY
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 NW 13TH ST # 261
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-2835
Mailing Address - Country:US
Mailing Address - Phone:941-416-0355
Mailing Address - Fax:
Practice Address - Street 1:2603 NW 13TH ST # 261
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-2835
Practice Address - Country:US
Practice Address - Phone:941-416-0355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach