Provider Demographics
NPI:1073807632
Name:WOLUGBOMS, NELLY O (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:NELLY
Middle Name:O
Last Name:WOLUGBOMS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:NELLY
Other - Middle Name:OGHOSOMI
Other - Last Name:ITSUOKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2711 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-5307
Mailing Address - Country:US
Mailing Address - Phone:615-620-8647
Mailing Address - Fax:615-515-5773
Practice Address - Street 1:100 DAMASCUS ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37074-1502
Practice Address - Country:US
Practice Address - Phone:615-227-3000
Practice Address - Fax:615-515-5773
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPRN0000015556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily