Provider Demographics
NPI:1306525084
Name:AYO-AMU, PEACE IHENOSEN (APRN)
Entity type:Individual
Prefix:MS
First Name:PEACE
Middle Name:IHENOSEN
Last Name:AYO-AMU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10901 BRIGHTON BAY BLVD NE APT 10208
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3459
Mailing Address - Country:US
Mailing Address - Phone:813-331-9074
Mailing Address - Fax:
Practice Address - Street 1:6506 EMBASSY BLVD
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-4734
Practice Address - Country:US
Practice Address - Phone:727-378-2987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily