Provider Demographics
NPI:1598904278
Name:EKWOTAFIA, ENITAN O (ARNP)
Entity Type:Individual
Prefix:
First Name:ENITAN
Middle Name:O
Last Name:EKWOTAFIA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 940220
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-0220
Mailing Address - Country:US
Mailing Address - Phone:407-384-1718
Mailing Address - Fax:407-384-1806
Practice Address - Street 1:5804 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE C
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-4346
Practice Address - Country:US
Practice Address - Phone:407-384-1718
Practice Address - Fax:407-384-1806
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9199718363L00000X
FLAPRN9199718363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner