Provider Demographics
NPI:1417580168
Name:AKINSADE, TIWALOLA OLABISI (FNP)
Entity Type:Individual
Prefix:
First Name:TIWALOLA
Middle Name:OLABISI
Last Name:AKINSADE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 HALPINE RD APT 1426
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-7628
Mailing Address - Country:US
Mailing Address - Phone:202-702-7242
Mailing Address - Fax:
Practice Address - Street 1:1496 REISTERSTOWN RD STE 220
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3819
Practice Address - Country:US
Practice Address - Phone:301-497-1590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR172396363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily