Provider Demographics
NPI:1922326743
Name:JAGUN, OLAYINKA AFUSAT (NP)
Entity Type:Individual
Prefix:MS
First Name:OLAYINKA
Middle Name:AFUSAT
Last Name:JAGUN
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 1:625 W 169TH ST
Mailing Address - Street 2:24D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2916
Mailing Address - Country:US
Mailing Address - Phone:212-928-8340
Mailing Address - Fax:
Practice Address - Street 1:785 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-1722
Practice Address - Country:US
Practice Address - Phone:718-589-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334627-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily