Provider Demographics
NPI:1467964221
Name:UDEGBUNE, TOCHUKWU TOBY (AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TOCHUKWU
Middle Name:TOBY
Last Name:UDEGBUNE
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:MRS
Other - First Name:TOCHUKWU
Other - Middle Name:
Other - Last Name:FRIMPONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5450 CLEARFORK MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3514
Mailing Address - Country:US
Mailing Address - Phone:817-334-1400
Mailing Address - Fax:
Practice Address - Street 1:5450 CLEARFORK MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-3514
Practice Address - Country:US
Practice Address - Phone:817-334-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135679363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health