Provider Demographics
NPI:1710594171
Name:OLUSOLA, TAIWO TOSIN (FNP)
Entity Type:Individual
Prefix:
First Name:TAIWO
Middle Name:TOSIN
Last Name:OLUSOLA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TAIWO
Other - Middle Name:TOSIN
Other - Last Name:OLUSOLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TAIWO OLUSOLA
Mailing Address - Street 1:8207 LONGVALE DR
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5046
Mailing Address - Country:US
Mailing Address - Phone:832-708-5515
Mailing Address - Fax:
Practice Address - Street 1:8207 LONGVALE DR
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77469-5046
Practice Address - Country:US
Practice Address - Phone:832-708-5515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1012028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily