Healthcare Provider Details

I. General information

NPI: 1003140575
Provider Name (Legal Business Name): TEARRA BREEZE OBAFOLAHAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2009
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6916 CLOISTER RD
TOLEDO OH
43617-2206
US

IV. Provider business mailing address

6916 CLOISTER RD
TOLEDO OH
43617-2206
US

V. Phone/Fax

Practice location:
  • Phone: 567-298-2344
  • Fax:
Mailing address:
  • Phone: 567-298-2344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0036369
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: