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General NPI Number Information
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NPI Number | 1942603170
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Entity Type | Individual
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Provider Name | FOLARIN OLATUNJI FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 350 E PARKVIEW ST
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City | DYERSBURG
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State | TN
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Zip | 38024-3122
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Country | US
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Telephone | 731-334-5312
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Fax | 731-334-5311
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Provider Business Mailing Address
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Address Line | 17 CENTRE PLAZA DR
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City | JACKSON
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State | TN
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Zip | 38305-2862
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Country | US
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Telephone | 731-512-0104
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Fax | 731-668-7388
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 19142
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 185452
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN0000019142
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License Number State | TN
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