Provider Demographics
NPI:1316382609
Name:ONUBOGU, ULOMA (ARNP, MSN, PHD)
Entity Type:Individual
Prefix:DR
First Name:ULOMA
Middle Name:
Last Name:ONUBOGU
Suffix:
Gender:F
Credentials:ARNP, MSN, PHD
Other - Prefix:
Other - First Name:ULOMA
Other - Middle Name:
Other - Last Name:DIKE-TONGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1060 WINTER LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-1267
Mailing Address - Country:US
Mailing Address - Phone:850-524-1577
Mailing Address - Fax:
Practice Address - Street 1:1060 WINTER LN
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-1267
Practice Address - Country:US
Practice Address - Phone:850-524-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2721822363L00000X, 363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009484200Medicaid
FL009484200Medicaid