Provider Demographics
NPI:1356050082
Name:OMONIYI, ANNIE MAUDE (RN)
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:MAUDE
Last Name:OMONIYI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MR
Other - First Name:ANNIE
Other - Middle Name:MAUDE
Other - Last Name:KUYE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1731 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-8554
Mailing Address - Country:US
Mailing Address - Phone:352-405-7077
Mailing Address - Fax:407-602-0015
Practice Address - Street 1:12643 NW 7TH PL
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-0169
Practice Address - Country:US
Practice Address - Phone:352-405-7077
Practice Address - Fax:407-602-0015
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9607983376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker