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NPI Code Detail

MEDICARE: IFEDAPO SOTUBO FNP

MEDICARE: IFEDAPO SOTUBO FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner1020827TX

General Provider Information

NPI Number : 1063000909
Entity Type Code : Individual
Provider Name (Legal Business Name) : IFEDAPO SOTUBO FNP
Provider Business Mailing Address
First Line : 325 N SAINT PAUL ST STE 3100
Second Line :
City : DALLAS
State : TX
Zip : 75201-3923
Country : US
Telephone Number : 888-731-8994
Fax Number :
Provider Business Practice Location Address
First Line : 325 N SAINT PAUL ST STE 3100
Second Line :
City : DALLAS
State : TX
Zip : 75201-3923
Country : US
Telephone Number : 888-731-8994
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2021
Last Update Date : 01/12/2026

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Directions to “ IFEDAPO SOTUBO FNP” Practice Location

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