Provider Demographics
NPI:1578114617
Name:AIGBOGUN, OSARUGUE CASSANDRA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:OSARUGUE
Middle Name:CASSANDRA
Last Name:AIGBOGUN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 OAKBEND TRL STE 250
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3914
Mailing Address - Country:US
Mailing Address - Phone:817-346-3366
Mailing Address - Fax:817-346-3710
Practice Address - Street 1:5801 OAKBEND TRL STE 250
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-3914
Practice Address - Country:US
Practice Address - Phone:817-346-3366
Practice Address - Fax:817-346-3710
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK215232363L00000X
TXAP143108363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner