Provider Demographics
NPI:1821569906
Name:OWOEYE, SEGUN MATHEW
Entity Type:Individual
Prefix:
First Name:SEGUN
Middle Name:MATHEW
Last Name:OWOEYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6413 TRENT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573-0119
Mailing Address - Country:US
Mailing Address - Phone:813-966-2594
Mailing Address - Fax:
Practice Address - Street 1:6413 TRENT CREEK DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573-0119
Practice Address - Country:US
Practice Address - Phone:813-966-2594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9381278163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse