Basic Information
Provider Information
NPI: 1619582087
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OREHIN
FirstName: FOLAKE
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1220 59TH ST W
Address2:  
City: BRADENTON
State: FL
PostalCode: 342094154
CountryCode: US
TelephoneNumber: 9412389900
FaxNumber: 9412389770
Practice Location
Address1: 4055 VALLEY VIEW LN STE 400
Address2:  
City: DALLAS
State: TX
PostalCode: 752445071
CountryCode: US
TelephoneNumber: 9727153800
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/12/2020
LastUpdateDate: 12/30/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/30/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN11010185FLY193400000X SINGLE SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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