| Olive Branch Way PLLC | |
|
245 Riverside Ave Ste 100 Jacksonville FL 32202-4930 | |
| (904) 575-0628 | |
| (904) 506-1326 |
| Full Name | Olive Branch Way PLLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 245 Riverside Ave Ste 100, Jacksonville, Florida |
| Authorized Official Name and Position | Sherekia Hales (OWNER) |
| Authorized Official Contact | 9047100398 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Olive Branch Way PLLC 5501 Wesconnett Blvd Unit 14846 Jacksonville FL 32238-7769 Ph: (904) 575-0628 | Olive Branch Way PLLC 245 Riverside Ave Ste 100 Jacksonville FL 32202-4930 Ph: (904) 575-0628 |
| NPI Number | 1972479137 |
|---|---|
| Provider Enumeration Date | 10/15/2025 |
| Last Update Date | 10/15/2025 |
| Certification Date | 09/29/2025 |
| Medicare PECOS PAC ID | 0749779254 |
|---|---|
| Medicare Enrollment ID | O20251027000287 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972479137 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| Provider Name | Sherekia Hales |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124590047 PECOS PAC ID: 2860834074 Enrollment ID: I20240520002274 |
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