Provider Demographics
NPI:1841821808
Name:SHORE, OLIVIA WHITE (APRN)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:WHITE
Last Name:SHORE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:OLIVIA
Other - Middle Name:SARAH
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4205 BELFORT RD STE 4015
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-3623
Mailing Address - Country:US
Mailing Address - Phone:904-450-6014
Mailing Address - Fax:904-450-6401
Practice Address - Street 1:1549 AIRPORT BLVD STE 200B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8634
Practice Address - Country:US
Practice Address - Phone:850-416-4600
Practice Address - Fax:850-416-2533
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005661363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily