MEDICARE: EMMA BERNICE OHAEGBULAM CNM ARNP

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
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	ARNP673682	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073536942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA BERNICE OHAEGBULAM CNM ARNP

Provider Business Mailing Address
First Line	:	13110 ELK MOUNTAIN DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7182
Country	:	US
Telephone Number	:	813-349-7568
Fax Number	:	813-349-7561

Provider Business Practice Location Address
First Line	:	508 N MARYLAND AVE
Second Line	:	PLANT CITY FAMILY CARE
City	:	PLANT CITY
State	:	FL
Zip	:	33563
Country	:	US
Telephone Number	:	813-349-7600
Fax Number	:	813-349-7561

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	12/07/2025

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