Provider Demographics
NPI:1154203883
Name:THE PROVIDER PARTNER, INC
Entity type:Organization
Organization Name:THE PROVIDER PARTNER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:689-208-9583
Mailing Address - Street 1:1420 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5727
Mailing Address - Country:US
Mailing Address - Phone:689-208-9583
Mailing Address - Fax:
Practice Address - Street 1:1420 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5727
Practice Address - Country:US
Practice Address - Phone:689-208-9583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization