Healthcare Provider Details

I. General information

NPI: 1538594387
Provider Name (Legal Business Name): TOLUWALASE OLUWAKEMI OGUNSOLA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2013
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 DRUID RD E
CLEARWATER FL
33756-4100
US

IV. Provider business mailing address

900 VILLAGE SQUARE XING STE 290
PALM BEACH GARDENS FL
33410-4552
US

V. Phone/Fax

Practice location:
  • Phone: 727-461-2282
  • Fax: 727-443-6170
Mailing address:
  • Phone: 239-232-1180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11016032
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: