Provider Demographics
NPI:1568692986
Name:AFILAKA, OLASUMBO T (CFNP)
Entity Type:Individual
Prefix:
First Name:OLASUMBO
Middle Name:T
Last Name:AFILAKA
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 FITZWILLIAM LN
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-4404
Mailing Address - Country:US
Mailing Address - Phone:302-981-8926
Mailing Address - Fax:
Practice Address - Street 1:703 FITZWILLIAM LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-4404
Practice Address - Country:US
Practice Address - Phone:302-981-8926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000499363L00000X
COC-APN.0100944-C-NP363LP0808X
TXAP134943363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner