Healthcare Provider Details

I. General information

NPI: 1437687894
Provider Name (Legal Business Name): FLORENCE TITILOLA EZE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 E BALTIMORE ST UNIT 1-R
BALTIMORE MD
21202-4706
US

IV. Provider business mailing address

3904 DEEP HOLLOW WAY
BOWIE MD
20721-1287
US

V. Phone/Fax

Practice location:
  • Phone: 240-245-4164
  • Fax:
Mailing address:
  • Phone: 240-245-4164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR207637
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberRN1031167
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: