Provider Demographics
NPI:1801255542
Name:FLORENCE OLADOKUN PLLC
Entity type:Organization
Organization Name:FLORENCE OLADOKUN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLADOKUN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:520-280-8999
Mailing Address - Street 1:115 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5201
Mailing Address - Country:US
Mailing Address - Phone:520-421-1120
Mailing Address - Fax:520-421-2877
Practice Address - Street 1:115 E 1ST ST
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5201
Practice Address - Country:US
Practice Address - Phone:520-421-1120
Practice Address - Fax:520-421-2877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN089452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ318073Medicaid