MEDICARE: OLAJUMOKE BASARU MPA,MSN, APRN,AGNP-C

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	363LG0600X	Gerontology Nurse Practitioner	1205482	TX

General Provider Information

NPI Number	:	1922998798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLAJUMOKE BASARU MPA,MSN, APRN,AGNP-C

Provider Business Mailing Address
First Line	:	13284 POND SPRINGS RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78729-7177
Country	:	US
Telephone Number	:	615-766-8003
Fax Number	:

Provider Business Practice Location Address
First Line	:	13284 POND SPRINGS RD
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78729-7177
Country	:	US
Telephone Number	:	615-766-8003
Fax Number	:

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

Provider Enumeration Date	:	07/03/2025
Last Update Date	:	07/04/2025

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