Provider Demographics
NPI:1982414777
Name:TAJOMAVWO, AMINAT TOBI (RN)
Entity type:Individual
Prefix:
First Name:AMINAT
Middle Name:TOBI
Last Name:TAJOMAVWO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TOBI
Other - Middle Name:
Other - Last Name:TAJOMAVWO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, BCD
Mailing Address - Street 1:4245 N CENTRAL EXPY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-4581
Mailing Address - Country:US
Mailing Address - Phone:469-554-9819
Mailing Address - Fax:
Practice Address - Street 1:4245 N CENTRAL EXPY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-4581
Practice Address - Country:US
Practice Address - Phone:469-554-9819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374J00000X
TX845592163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Multi-Specialty
No374J00000XNursing Service Related ProvidersDoula