Healthcare Provider Details

I. General information

NPI: 1417517285
Provider Name (Legal Business Name): GLORIA FUNBI IGBOIN MSN, RN, FNP, PMH-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS GLORIA FUNBI TOYINBO

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 S WATER TOWER PL
MOUNT VERNON IL
62864-2349
US

IV. Provider business mailing address

4001 S WATER TOWER PL APT 234
MOUNT VERNON IL
62864-6593
US

V. Phone/Fax

Practice location:
  • Phone: 618-246-2910
  • Fax:
Mailing address:
  • Phone: 727-424-8784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11002204
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: