MEDICARE: TRANQUILITY MEDICAL SERVICES, LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1891687117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANQUILITY MEDICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	2333 MORRIS AVE STE C202
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-5747
Country	:	US
Telephone Number	:	908-292-0442
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 MORRIS AVE STE C202
Second Line	:
City	:	UNION
State	:	NJ
Zip	:	07083-5747
Country	:	US
Telephone Number	:	908-292-0442
Fax Number	:

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MR. OLUFISAYO A OWOLABI
Credential	:	APN
Telephone Number	:	908-292-0442

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	07/21/2025

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