Healthcare Provider Details

I. General information

NPI: 1861279515
Provider Name (Legal Business Name): YAOVI ANTONY GBOGBO DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 NE FOUNTAIN VIEW DR
ANKENY IA
50021-4506
US

IV. Provider business mailing address

1002 NE FOUNTAIN VIEW DR
ANKENY IA
50021-4506
US

V. Phone/Fax

Practice location:
  • Phone: 712-301-9628
  • Fax:
Mailing address:
  • Phone: 712-301-9628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA176370
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: