Provider Demographics
NPI:1679046338
Name:GBADEBO, ADEFUNKE OLUFUNKE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ADEFUNKE
Middle Name:OLUFUNKE
Last Name:GBADEBO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:ADEFUNKE
Other - Middle Name:O
Other - Last Name:GBADEBO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2626 CAPITAL MEDICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4402
Mailing Address - Country:US
Mailing Address - Phone:850-325-5000
Mailing Address - Fax:
Practice Address - Street 1:1891 CAPITAL CIR NE STE 9
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4486
Practice Address - Country:US
Practice Address - Phone:888-698-2714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-05
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9218334163W00000X
FLAPRN11002044363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse