Provider Demographics
NPI:1720051840
Name:BAMGBOSE, FLORENCE P (ARNP)
Entity Type:Individual
Prefix:MS
First Name:FLORENCE
Middle Name:P
Last Name:BAMGBOSE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:FLORENCE
Other - Middle Name:
Other - Last Name:BAMGBOSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:6271 WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-8526
Mailing Address - Country:US
Mailing Address - Phone:850-264-9070
Mailing Address - Fax:850-671-2869
Practice Address - Street 1:1835 BUFORD CT
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4465
Practice Address - Country:US
Practice Address - Phone:850-459-7949
Practice Address - Fax:850-671-2869
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3314182363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY074DOtherBC/BS FLORIDA
FLP56944OtherVISTA (MCD)
FL305043200Medicaid
FLY074DOtherBC/BS FLORIDA
FLP56944Medicare UPIN