Healthcare Provider Details

I. General information

NPI: 1033987979
Provider Name (Legal Business Name): TOBI SAMUEL ADEBOYEJO PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2023
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1632 W COLONIAL PKWY
INVERNESS IL
60067-4725
US

IV. Provider business mailing address

1632 W COLONIAL PKWY
INVERNESS IL
60067-4725
US

V. Phone/Fax

Practice location:
  • Phone: 331-275-6095
  • Fax:
Mailing address:
  • Phone: 847-510-7046
  • Fax: 847-631-3760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209035234
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: