Provider Demographics
NPI:1447633771
Name:OGAGA, FODE JUDE
Entity type:Individual
Prefix:MR
First Name:FODE
Middle Name:JUDE
Last Name:OGAGA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:FODE
Other - Middle Name:KABA
Other - Last Name:SYLLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 953935
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32795-3935
Mailing Address - Country:US
Mailing Address - Phone:407-732-7957
Mailing Address - Fax:407-732-7925
Practice Address - Street 1:520 FALKENBURG RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619
Practice Address - Country:US
Practice Address - Phone:813-247-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-06
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9289140163WM0705X, 363LF0000X, 376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No376G00000XNursing Service Related ProvidersNursing Home Administrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP 9289140Medicaid