Provider Demographics
NPI:1316688468
Name:AKINTOLA, OLUSOLA R (NP)
Entity type:Individual
Prefix:
First Name:OLUSOLA
Middle Name:R
Last Name:AKINTOLA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 JACK MARTIN BLVD # D1
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3063
Mailing Address - Country:US
Mailing Address - Phone:732-458-5854
Mailing Address - Fax:732-458-8012
Practice Address - Street 1:210 JACK MARTIN BLVD # D1
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3063
Practice Address - Country:US
Practice Address - Phone:732-458-5854
Practice Address - Fax:732-458-8012
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01290100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily