Provider Demographics
NPI:1013488089
Name:AKINLOLU, ELIZABETH OLAYINKA
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:OLAYINKA
Last Name:AKINLOLU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 LONGBOAT AVE
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08722-4304
Mailing Address - Country:US
Mailing Address - Phone:732-240-2510
Mailing Address - Fax:
Practice Address - Street 1:1324 LONGBOAT AVE
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08722-4304
Practice Address - Country:US
Practice Address - Phone:732-240-2510
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
NJ26NJ00885200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty