Healthcare Provider Details

I. General information

NPI: 1215503354
Provider Name (Legal Business Name): GERALDA BETTINA OLUWAGBAMILA DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2021
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BRITTON PL STE 6
VOORHEES NJ
08043-2514
US

IV. Provider business mailing address

1 BRITTON PL STE 6
VOORHEES NJ
08043-2514
US

V. Phone/Fax

Practice location:
  • Phone: 856-412-4694
  • Fax: 856-412-4758
Mailing address:
  • Phone: 856-412-4694
  • Fax: 856-412-4758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ01134600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: