Provider Demographics
NPI:1518389139
Name:ASSAN-OBISANYA, BOLA (ARNP)
Entity Type:Individual
Prefix:
First Name:BOLA
Middle Name:
Last Name:ASSAN-OBISANYA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:BOLA
Other - Middle Name:
Other - Last Name:ASSAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 NW 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7809
Mailing Address - Country:US
Mailing Address - Phone:954-424-7505
Mailing Address - Fax:
Practice Address - Street 1:100 NW 82ND AVE
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-7809
Practice Address - Country:US
Practice Address - Phone:954-424-7505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-16
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9172635363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily