Provider Demographics
NPI:1962982207
Name:FASHOLA, AZEEZAT (NP)
Entity type:Individual
Prefix:
First Name:AZEEZAT
Middle Name:
Last Name:FASHOLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18956 N DALE MABRY HWY
Mailing Address - Street 2:STE 102
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33548-4915
Mailing Address - Country:US
Mailing Address - Phone:813-948-8597
Mailing Address - Fax:813-949-5919
Practice Address - Street 1:18956 N DALE MABRY HWY STE 102
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33548-4915
Practice Address - Country:US
Practice Address - Phone:813-948-8597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9330713363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily