Provider Demographics
NPI:1972786358
Name:AYOOLA, ENIOLA (PA)
Entity type:Individual
Prefix:
First Name:ENIOLA
Middle Name:
Last Name:AYOOLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10250 SE 167TH PLACE RD UNIT 5
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-8682
Mailing Address - Country:US
Mailing Address - Phone:352-307-9925
Mailing Address - Fax:352-307-8442
Practice Address - Street 1:10250 SE 167TH PLACE RD UNIT 5
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-8682
Practice Address - Country:US
Practice Address - Phone:352-307-9925
Practice Address - Fax:352-307-8442
Is Sole Proprietor?:No
Enumeration Date:2007-12-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104349363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001558000Medicaid