Healthcare Provider Details

I. General information

NPI: 1376520577
Provider Name (Legal Business Name): NGOZI ODOH PHD, APRN,GNP,ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7620 LAKE UNDERHILL RD
ORLANDO FL
32822-8223
US

IV. Provider business mailing address

2750 TAYLOR AVE
ORLANDO FL
32806-4474
US

V. Phone/Fax

Practice location:
  • Phone: 321-235-0692
  • Fax: 321-235-0694
Mailing address:
  • Phone: 407-754-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP2805762
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: