Healthcare Provider Details

I. General information

NPI: 1962293753
Provider Name (Legal Business Name): OLUROPO OGUNTI APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 FELI WAY
CRAWFORDVILLE FL
32327-2368
US

IV. Provider business mailing address

405 SE 4TH ST
HAVANA FL
32333-2111
US

V. Phone/Fax

Practice location:
  • Phone: 850-926-3163
  • Fax:
Mailing address:
  • Phone: 850-631-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11038542
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: