Healthcare Provider Details

I. General information

NPI: 1831548213
Provider Name (Legal Business Name): OLUWOLE PITAN ARNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9835 E HIBISCUS ST
PALMETTO BAY FL
33157-5406
US

IV. Provider business mailing address

10122 SW 139TH ST
MIAMI FL
33176-6682
US

V. Phone/Fax

Practice location:
  • Phone: 305-238-8561
  • Fax: 305-238-4089
Mailing address:
  • Phone: 786-201-6249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9328218
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number9328218
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number9328218
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9328218
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: