Provider Demographics
NPI:1154899383
Name:OLASOJI, IRIS BOSEDE
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:BOSEDE
Last Name:OLASOJI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5753 ROYAL HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-8794
Mailing Address - Country:US
Mailing Address - Phone:863-662-9843
Mailing Address - Fax:
Practice Address - Street 1:5753 ROYAL HILLS CIR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-8794
Practice Address - Country:US
Practice Address - Phone:863-662-9843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9305389363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily