Healthcare Provider Details

I. General information

NPI: 1447633771
Provider Name (Legal Business Name): MR. FODE JUDE OGAGA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: FODE KABA SYLLA ARNP

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 05/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 FALKENBURG RD
TAMPA FL
33619
US

IV. Provider business mailing address

PO BOX 953935
LAKE MARY FL
32795-3935
US

V. Phone/Fax

Practice location:
  • Phone: 813-247-8300
  • Fax:
Mailing address:
  • Phone: 407-732-7957
  • Fax: 407-732-7925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number9289140
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9289140
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number9289140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: