Provider Demographics
NPI:1366833105
Name:OGBEKHILU, EDDY T
Entity Type:Individual
Prefix:
First Name:EDDY
Middle Name:T
Last Name:OGBEKHILU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17607 SIMMONS RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4596
Mailing Address - Country:US
Mailing Address - Phone:813-506-1432
Mailing Address - Fax:
Practice Address - Street 1:17607 SIMMONS RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4596
Practice Address - Country:US
Practice Address - Phone:813-506-1432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5180181164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse