Provider Demographics
NPI:1376054718
Name:OLATUNJI, ADEBAYO T (NP)
Entity Type:Individual
Prefix:MR
First Name:ADEBAYO
Middle Name:T
Last Name:OLATUNJI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1401 BELL RANCH CIR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-4974
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:306 E RANDOL MILL RD STE 136
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5841
Practice Address - Country:US
Practice Address - Phone:817-697-4619
Practice Address - Fax:817-984-8544
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF10170653363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily