Healthcare Provider Details

I. General information

NPI: 1457952319
Provider Name (Legal Business Name): OLUFUNKE OYINDAMOLA OSHOBA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1752 BROAD PARK CIR N STE 114
MANSFIELD TX
76063-7824
US

IV. Provider business mailing address

2340 E TRINITY MILLS RD STE 250
CARROLLTON TX
75006-1946
US

V. Phone/Fax

Practice location:
  • Phone: 855-893-5637
  • Fax: 817-666-3873
Mailing address:
  • Phone: 855-893-5637
  • Fax: 817-666-3873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1016994
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: