Healthcare Provider Details

I. General information

NPI: 1073536942
Provider Name (Legal Business Name): EMMA BERNICE OHAEGBULAM CNM ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMMA BOLDEN

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 N MARYLAND AVE PLANT CITY FAMILY CARE
PLANT CITY FL
33563
US

IV. Provider business mailing address

13110 ELK MOUNTAIN DR
RIVERVIEW FL
33579-7182
US

V. Phone/Fax

Practice location:
  • Phone: 813-349-7600
  • Fax: 813-349-7561
Mailing address:
  • Phone: 813-349-7568
  • Fax: 813-349-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberARNP673682
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: