Healthcare Provider Details

I. General information

NPI: 1023732609
Provider Name (Legal Business Name): ABIDEMI OLAOYE AJIBOLA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 W JORDAN ST STE 150
PENSACOLA FL
32501-1740
US

IV. Provider business mailing address

14 W JORDAN ST STE 150
PENSACOLA FL
32501-1740
US

V. Phone/Fax

Practice location:
  • Phone: 850-455-1252
  • Fax: 844-683-8754
Mailing address:
  • Phone: 850-455-1252
  • Fax: 844-683-8754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11021967
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN11021967
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: