Provider Demographics
NPI:1154621688
Name:AJOKU, BOURNE CHIDI (RN)
Entity type:Individual
Prefix:MR
First Name:BOURNE
Middle Name:CHIDI
Last Name:AJOKU
Suffix:
Gender:M
Credentials:RN
Other - Prefix:MRS
Other - First Name:SARAH
Other - Middle Name:LYNETT
Other - Last Name:AJOKU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:2303 BELL SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-6608
Mailing Address - Country:US
Mailing Address - Phone:662-544-3852
Mailing Address - Fax:
Practice Address - Street 1:2303 BELL SHOALS RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6608
Practice Address - Country:US
Practice Address - Phone:662-544-3852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9307203163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse