MEDICARE: FLORENCE OGUNTUASE

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	164W00000X	Licensed Practical Nurse	PN5253028	FL

General Provider Information

NPI Number	:	1831820273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FLORENCE OGUNTUASE

Provider Business Mailing Address
First Line	:	500 EXECUTIVE DRIVE
Second Line	:	APARTMENT 4N
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5737 OKEECHOBEE BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-4366
Country	:	US
Telephone Number	:	561-971-2666
Fax Number	:

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

Provider Enumeration Date	:	06/17/2022
Last Update Date	:	06/17/2022

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