Provider Demographics
NPI:1124503347
Name:ADEYANJU, VINCENT
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:ADEYANJU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 E HILLSBOROUGH AVE STE D&E
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-5200
Mailing Address - Country:US
Mailing Address - Phone:813-443-0801
Mailing Address - Fax:813-628-8484
Practice Address - Street 1:4505 E HILLSBOROUGH AVE STE D&E
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-5200
Practice Address - Country:US
Practice Address - Phone:813-443-0801
Practice Address - Fax:813-628-8484
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5184175164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse