Provider Demographics
NPI:1932525920
Name:AGBOOLA, OLOLADE (NP)
Entity Type:Individual
Prefix:
First Name:OLOLADE
Middle Name:
Last Name:AGBOOLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 ATLANTIS DR STE A
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-1637
Mailing Address - Country:US
Mailing Address - Phone:281-707-0939
Mailing Address - Fax:
Practice Address - Street 1:1411 ATLANTIS DR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1637
Practice Address - Country:US
Practice Address - Phone:281-707-0939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9355378163W00000X
TX1084523363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse