Provider Demographics
NPI:1134372865
Name:OLATUBOSUN, GLORIA O (RN FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:O
Last Name:OLATUBOSUN
Suffix:
Gender:F
Credentials:RN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CREEKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BORDENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08505-4809
Mailing Address - Country:US
Mailing Address - Phone:609-284-2373
Mailing Address - Fax:
Practice Address - Street 1:22 CREEKWOOD DR
Practice Address - Street 2:
Practice Address - City:BORDENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08505-4809
Practice Address - Country:US
Practice Address - Phone:609-499-9723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-25
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00379500363LF0000X
NJ26NO11077300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily