Provider Demographics
NPI:1871317230
Name:ESOGA, NKECHINYERE
Entity type:Individual
Prefix:
First Name:NKECHINYERE
Middle Name:
Last Name:ESOGA
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 1:6030 S FLORIDA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-3351
Mailing Address - Country:US
Mailing Address - Phone:863-644-9800
Mailing Address - Fax:
Practice Address - Street 1:6030 S FLORIDA AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-3351
Practice Address - Country:US
Practice Address - Phone:863-644-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11035950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily