Healthcare Provider Details

I. General information

NPI: 1326733304
Provider Name (Legal Business Name): VICTORIA OGUNLEYE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 43RD TER SE
SAINT PETERSBURG FL
33705-4303
US

IV. Provider business mailing address

298 43RD TER SE
SAINT PETERSBURG FL
33705-4303
US

V. Phone/Fax

Practice location:
  • Phone: 727-244-4253
  • Fax:
Mailing address:
  • Phone: 727-244-4253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9337716
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: