Healthcare Provider Details

I. General information

NPI: 1245679257
Provider Name (Legal Business Name): MISS FLORENCE OLUFUNKE OGUNKUNLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2037 SAINT MATTHEWS RD
ORANGEBURG SC
29118-2036
US

IV. Provider business mailing address

PO BOX 1704
ORANGEBURG SC
29116-1704
US

V. Phone/Fax

Practice location:
  • Phone: 803-515-4617
  • Fax: 803-662-9207
Mailing address:
  • Phone: 803-515-4617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number105765
License Number StateSC
# 5
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number14324
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: