Healthcare Provider Details

I. General information

NPI: 1801697677
Provider Name (Legal Business Name): MUTIU GBADEGESIN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7233 SOMERSET POND DR
RUSKIN FL
33573-0127
US

IV. Provider business mailing address

7233 SOMERSET POND DR
RUSKIN FL
33573-0127
US

V. Phone/Fax

Practice location:
  • Phone: 813-447-2973
  • Fax:
Mailing address:
  • Phone: 813-447-2973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9505098
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: