Provider Demographics
NPI:1073108445
Name:DLIGHTHOUSE
Entity Type:Organization
Organization Name:DLIGHTHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:TOLULOPE
Authorized Official - Middle Name:FOLARANMI
Authorized Official - Last Name:AJANI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:813-516-1330
Mailing Address - Street 1:32762 PEZ LANDING LN
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-7259
Mailing Address - Country:US
Mailing Address - Phone:813-516-1330
Mailing Address - Fax:
Practice Address - Street 1:32762 PEZ LANDING LN
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-7259
Practice Address - Country:US
Practice Address - Phone:813-516-1330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-07
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty