Provider Demographics
NPI:1730304916
Name:ADEBANJO, TITILOLA TOLULOPE (NP)
Entity Type:Individual
Prefix:MRS
First Name:TITILOLA
Middle Name:TOLULOPE
Last Name:ADEBANJO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-9207
Mailing Address - Country:US
Mailing Address - Phone:901-853-4146
Mailing Address - Fax:901-685-1997
Practice Address - Street 1:756 RIDGE LAKE BLVD
Practice Address - Street 2:SUITE 228
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-9420
Practice Address - Country:US
Practice Address - Phone:901-685-1994
Practice Address - Fax:901-685-1997
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012501363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care