Individual provider Active NPI

Tina M Olson, FNP

  • Family Nurse Practitioner
  • Stony Brook, NY
National Provider Identifier
1700117686
Registry record updated Apr 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F344921 Issued in NY
Practice address
101 Nicolls Rd
Stony Brook, NY 11794-0001
Phone
(631) 444-4680
NPI assigned
Jan 16, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F344921 NY Primary
Registered Nurse 163W00000X 619164-1 NY

Addresses

Primary practice location

101 Nicolls Rd
Stony Brook, NY 11794-0001

Mailing address

61 Piedmont Dr Apt 214B
Port Jefferson Station, NY 11776-1127
Phone (631) 745-3339

Other practice location 1

61 Piedmont Dr Apt 214B
Port Jefferson Station, NY 11776
Phone (631) 745-3339

Other identifiers 1

IdentifierTypeStateIssuer
619164-1MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Tina.Olson@DIRECT.STONYBROOKMEDICINE.EDU Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
619164-1NYMDRegistered Nurse
F344921NYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
University Associates in Obstetrics & Gynecology, University Faculty P CurrentSince Oct 21, 2019 Accepting new patients
University Hospital at Stony Brook Current Accepting new patients

Locations

6 Technology Dr
Setauket, NY 11733
Phone (631) 444-2790

101 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-2065

100 Nicolls Rd
Stony Brook, NY 11794
Phone (631) 444-1560

Networks

  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H1722

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650412800000",
    "number": "1700117686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 PIEDMONT DR APT 214B",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761127",
            "telephone_number": "631-745-3339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 NICOLLS RD",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117940001",
            "telephone_number": "631-444-4680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "61 Piedmont Dr Apt 214B",
            "address_purpose": "LOCATION",
            "city": "Port Jefferson Station",
            "state": "NY",
            "postal_code": "11776",
            "country_code": "US",
            "telephone_number": "631-745-3339",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "OLSON",
        "first_name": "TINA",
        "middle_name": "M",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-16",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F344921",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "619164-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "619164-1",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Tina.Olson@DIRECT.STONYBROOKMEDICINE.EDU",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "101 Nicolls Rd",
            "city": "Stony Brook",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117940001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.