Healthcare Provider Details

I. General information

NPI: 1710771423
Provider Name (Legal Business Name): TOLULOPE ADEDAYO OLOJEDE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2025
Last Update Date: 11/01/2025
Certification Date: 11/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 N DR MARTIN LUTHER KING JR BLVD
CLOVIS NM
88101-9401
US

IV. Provider business mailing address

2301 N DR MARTIN LUTHER KING JR BLVD
CLOVIS NM
88101-9401
US

V. Phone/Fax

Practice location:
  • Phone: 469-237-4933
  • Fax:
Mailing address:
  • Phone: 469-237-4933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.0104973
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number101.0138359TELE
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number83596
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number39348
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024193517
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: