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General NPI Number Information
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NPI Number | 1548123110
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Entity Type | Individual
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Provider Name | BRENIQUE NAOMI ADEMOLA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 12977 SOUTHERN BLVD STE 202
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City | LOXAHATCHEE
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State | FL
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Zip | 33470-9256
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Country | US
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Telephone | 561-879-4006
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Fax | 561-879-4008
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Provider Business Mailing Address
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Address Line | 324 SE HURON TER
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34983-2649
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Country | US
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Telephone | 410-946-7716
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11044091
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License Number State | FL
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