MEDICARE: NJIDEKA OBIAGELI NNADOZIE APRN

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	11038759	FL

General Provider Information

NPI Number	:	1609766567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NJIDEKA OBIAGELI NNADOZIE APRN

Provider Business Mailing Address
First Line	:	9911 PALERMO BREEZE WAY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-5010
Country	:	US
Telephone Number	:	850-480-2197
Fax Number	:

Provider Business Practice Location Address
First Line	:	4912 W TRAPNELL RD
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33566-0128
Country	:	US
Telephone Number	:	813-417-4767
Fax Number	:

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

Provider Enumeration Date	:	07/03/2025
Last Update Date	:	08/05/2025

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