Provider Demographics
NPI:1144317876
Name:OLSON, MARTHA ANN (PA)
Entity type:Individual
Prefix:MISS
First Name:MARTHA
Middle Name:ANN
Last Name:OLSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:10 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:FL
Mailing Address - Zip Code:32725-8106
Mailing Address - Country:US
Mailing Address - Phone:386-507-5269
Mailing Address - Fax:855-879-6592
Practice Address - Street 1:701 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7313
Practice Address - Country:US
Practice Address - Phone:352-326-8115
Practice Address - Fax:352-326-5282
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPAT9103766363AS0400X
FLPA9103766363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical