Healthcare Provider Details

I. General information

NPI: 1588457295
Provider Name (Legal Business Name): TOYOSI FAGBEMI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5122 W REGENT ST
INDIANAPOLIS IN
46241-4750
US

IV. Provider business mailing address

5122 W REGENT ST
INDIANAPOLIS IN
46241-4750
US

V. Phone/Fax

Practice location:
  • Phone: 317-970-4676
  • Fax:
Mailing address:
  • Phone: 317-970-4676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number71017057A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: