Healthcare Provider Details

I. General information

NPI: 1770257354
Provider Name (Legal Business Name): ABIODUN OLUWOLE OGUNREMI DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 S MONROE ST FL 1
TALLAHASSEE FL
32301-1529
US

IV. Provider business mailing address

1720 S GADSDEN ST
TALLAHASSEE FL
32301-5506
US

V. Phone/Fax

Practice location:
  • Phone: 850-343-4446
  • Fax:
Mailing address:
  • Phone: 850-576-4073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11014667
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11014667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: