Provider Demographics
NPI:1649984436
Name:AKINBOBOLA, OLUYINKA O (FNP)
Entity type:Individual
Prefix:MR
First Name:OLUYINKA
Middle Name:O
Last Name:AKINBOBOLA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RICHARD AVE
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-3353
Mailing Address - Country:US
Mailing Address - Phone:240-421-1597
Mailing Address - Fax:
Practice Address - Street 1:800 INGLESIDE AVE STE C1
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-1722
Practice Address - Country:US
Practice Address - Phone:240-421-1597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR239820363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily