Active NPI
Edgard Olivier
- Nurse Practitioner
- Pembroke Pines, FL
National Provider Identifier
1639923667
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 11024092
- Practice address
- 1301 SW 97TH Ave
Pembroke Pines, FL 33025-3684 - Phone
- (786) 294-2103
- NPI assigned
- Apr 16, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | F12220196 | FL | |
| Nurse Practitioner | 363L00000X | 11024092 | FL | Primary |
Addresses
Primary practice location
1301 SW 97TH Ave
Pembroke Pines, FL 33025-3684
Mailing address
1301 SW 97TH Ave
Pembroke Pines, FL 33025-3684
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F12220196 | FL | MD | Family Medicine Physician |
| 11024092 | FL | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1713225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714521600000",
"number": "1639923667",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 SW 97TH AVE",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330253684"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 SW 97TH AVE",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330253684",
"telephone_number": "786-294-2103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLIVIER",
"first_name": "EDGARD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-04-16",
"last_updated": "2024-05-01",
"certification_date": "2024-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "F12220196",
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "FL",
"license": "11024092",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pembroke Pines, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.