Healthcare Provider Details

I. General information

NPI: 1679046338
Provider Name (Legal Business Name): ADEFUNKE OLUFUNKE GBADEBO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. ADEFUNKE O GBADEBO

II. Dates (important events)

Enumeration Date: 01/05/2019
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1891 CAPITAL CIR NE STE 9
TALLAHASSEE FL
32308-4486
US

IV. Provider business mailing address

2626 CAPITAL MEDICAL BLVD
TALLAHASSEE FL
32308-4402
US

V. Phone/Fax

Practice location:
  • Phone: 888-698-2714
  • Fax:
Mailing address:
  • Phone: 850-325-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9218334
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11002044
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: