Provider Demographics
NPI:1295274371
Name:AFOLABI, MOJISOLA (NP)
Entity type:Individual
Prefix:
First Name:MOJISOLA
Middle Name:
Last Name:AFOLABI
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 1:12332 RACE TRACK RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3115
Mailing Address - Country:US
Mailing Address - Phone:813-756-4383
Mailing Address - Fax:224-330-1550
Practice Address - Street 1:12332 RACE TRACK RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3115
Practice Address - Country:US
Practice Address - Phone:813-756-4383
Practice Address - Fax:224-330-1550
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN01470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily