Healthcare Provider Details

I. General information

NPI: 1609422567
Provider Name (Legal Business Name): FUNMILAYO AKINJAGUNLA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 VIEW ST
FORT WORTH TX
76103-2425
US

IV. Provider business mailing address

PO BOX 74008272
CHICAGO IL
60674-8272
US

V. Phone/Fax

Practice location:
  • Phone: 872-899-0595
  • Fax:
Mailing address:
  • Phone: 702-899-0595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1169898
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number974515
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: