Provider Demographics
NPI:1992416275
Name:ONUORAH, IMMACULATA
Entity type:Individual
Prefix:
First Name:IMMACULATA
Middle Name:
Last Name:ONUORAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 FERN GULLEY DR
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-3733
Mailing Address - Country:US
Mailing Address - Phone:727-776-9819
Mailing Address - Fax:
Practice Address - Street 1:3401 E LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-6531
Practice Address - Country:US
Practice Address - Phone:813-238-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9333244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily