Provider Demographics
NPI:1043561277
Name:OLAGBAIYE, TEMITOPE OLADOKUN (NP)
Entity type:Individual
Prefix:
First Name:TEMITOPE
Middle Name:OLADOKUN
Last Name:OLAGBAIYE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5131 QUINCE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-6846
Mailing Address - Country:US
Mailing Address - Phone:901-701-1888
Mailing Address - Fax:901-701-1136
Practice Address - Street 1:5131 QUINCE RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-6846
Practice Address - Country:US
Practice Address - Phone:901-701-1888
Practice Address - Fax:901-701-1136
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704252765363LF0000X
TN33656363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4704252765OtherSTATE LICENSE NUMBER