Provider Demographics
NPI:1740880848
Name:ODAZIE, HENRY (FNP-C)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:ODAZIE
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 NW 31ST AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3403
Mailing Address - Country:US
Mailing Address - Phone:954-496-2599
Mailing Address - Fax:
Practice Address - Street 1:4513 NW 31ST AVE STE 1
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-3403
Practice Address - Country:US
Practice Address - Phone:954-496-2599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-28
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9485891363LF0000X
FL11009931363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily