Healthcare Provider Details

I. General information

NPI: 1508444191
Provider Name (Legal Business Name): OLUSEGUN DAVID ASUBIOJO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 GULF BREEZE PKWY STE B
GULF BREEZE FL
32561-4851
US

IV. Provider business mailing address

PO BOX 95590
SOUTH JORDAN UT
84095-0590
US

V. Phone/Fax

Practice location:
  • Phone: 448-227-4650
  • Fax: 850-916-3689
Mailing address:
  • Phone: 801-352-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11011600
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: