MEDICARE: IRIS BOSEDE OLASOJI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN9305389	FL

General Provider Information

NPI Number	:	1154899383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRIS BOSEDE OLASOJI

Provider Business Mailing Address
First Line	:	5753 ROYAL HILLS CIR
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-8794
Country	:	US
Telephone Number	:	863-662-9843
Fax Number	:

Provider Business Practice Location Address
First Line	:	5753 ROYAL HILLS CIR
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-8794
Country	:	US
Telephone Number	:	863-662-9843
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2018
Last Update Date	:	11/06/2018

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Directions to “ IRIS BOSEDE OLASOJI ” Practice Location

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