Provider Demographics
NPI:1831548213
Name:PITAN, OLUWOLE (ARNP-BC)
Entity type:Individual
Prefix:MR
First Name:OLUWOLE
Middle Name:
Last Name:PITAN
Suffix:
Gender:
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10122 SW 139TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-6682
Mailing Address - Country:US
Mailing Address - Phone:786-201-6249
Mailing Address - Fax:
Practice Address - Street 1:9835 E HIBISCUS ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5406
Practice Address - Country:US
Practice Address - Phone:305-238-8561
Practice Address - Fax:305-238-4089
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9328218163W00000X, 363LP0808X, 376G00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No376G00000XNursing Service Related ProvidersNursing Home Administrator