Healthcare Provider Details

I. General information

NPI: 1730304916
Provider Name (Legal Business Name): TITILOLA TOLULOPE ADEBANJO N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

756 RIDGE LAKE BLVD SUITE 228
MEMPHIS TN
38120-9420
US

IV. Provider business mailing address

1020 CENTER RIDGE RD
COLLIERVILLE TN
38017-9207
US

V. Phone/Fax

Practice location:
  • Phone: 901-685-1994
  • Fax: 901-685-1997
Mailing address:
  • Phone: 901-853-4146
  • Fax: 901-685-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPN0000012501
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: