Provider Demographics
NPI:1700166675
Name:GILLESPIE, OLIVIA (DO)
Entity type:Individual
Prefix:DR
First Name:OLIVIA
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 COUNTRYSIDE BLVD STE H
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1603
Mailing Address - Country:US
Mailing Address - Phone:727-796-8600
Mailing Address - Fax:727-796-8660
Practice Address - Street 1:2515 COUNTRYSIDE BLVD STE H
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1603
Practice Address - Country:US
Practice Address - Phone:727-796-8600
Practice Address - Fax:727-796-8660
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11887207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266258200Medicaid
FLHS240ZMedicare PIN