Provider Demographics
NPI:1457776064
Name:AZEEZ, BUKOLA SUKURAT (FNP)
Entity Type:Individual
Prefix:
First Name:BUKOLA
Middle Name:SUKURAT
Last Name:AZEEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 E RUNDBERG LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-4808
Mailing Address - Country:US
Mailing Address - Phone:512-978-9600
Mailing Address - Fax:512-901-9726
Practice Address - Street 1:825 E RUNDBERG LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-4808
Practice Address - Country:US
Practice Address - Phone:512-978-9600
Practice Address - Fax:512-901-9726
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125090363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily