Basic Information
| Provider Information | |||||||||
| NPI: | 1306250386 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADELUFOSI | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | OMOLARA | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 OAKFIELD DR | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136842229 | ||||||||
| FaxNumber: | 8134138508 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 OAKFIELD DR | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136842229 | ||||||||
| FaxNumber: | 8134138508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2014 | ||||||||
| LastUpdateDate: | 12/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | APRN9310377 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LG0600X | APRN9310377 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 015679600 | 05 | FL | MEDICAID | L7288 | 01 | FL | MEDICARE | OTHER | 04N17 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER |