Provider Demographics
NPI:1205529674
Name:ADEJOLA, ESSAR (RN)
Entity type:Individual
Prefix:
First Name:ESSAR
Middle Name:
Last Name:ADEJOLA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 SW ABISCO RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2896
Mailing Address - Country:US
Mailing Address - Phone:561-502-6395
Mailing Address - Fax:
Practice Address - Street 1:1239 SW ABISCO RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2896
Practice Address - Country:US
Practice Address - Phone:561-502-6395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9418417163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse