Provider Demographics
NPI:1548743958
Name:MOGBO, IFEOMA LINDA (DNP, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:IFEOMA
Middle Name:LINDA
Last Name:MOGBO
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:MS
Other - First Name:IFEOMA
Other - Middle Name:LINDA
Other - Last Name:AGU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-BC
Mailing Address - Street 1:2700 W PECAN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3069
Mailing Address - Country:US
Mailing Address - Phone:512-421-3750
Mailing Address - Fax:512-421-3751
Practice Address - Street 1:2700 W PECAN ST STE 102
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-3069
Practice Address - Country:US
Practice Address - Phone:512-421-3750
Practice Address - Fax:512-421-3751
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137556363L00000X
TX801838363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner