Healthcare Provider Details

I. General information

NPI: 1003268558
Provider Name (Legal Business Name): BOLANLE ADETUTU TORIOLA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2016
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 PARK GROVE DR
KATY TX
77450-1759
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-0859
US

V. Phone/Fax

Practice location:
  • Phone: 409-266-1888
  • Fax:
Mailing address:
  • Phone: 281-515-2504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP130551
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP130551
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: