Provider Demographics
NPI:1992310445
Name:SPENCER, OLUFUNMIKE (APRN)
Entity type:Individual
Prefix:
First Name:OLUFUNMIKE
Middle Name:
Last Name:SPENCER
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 1:20200 W DIXIE HWY STE 1108
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1922
Mailing Address - Country:US
Mailing Address - Phone:786-275-3725
Mailing Address - Fax:
Practice Address - Street 1:20200 W DIXIE HWY STE 1108
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1922
Practice Address - Country:US
Practice Address - Phone:786-275-3725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily