Provider Demographics
NPI:1053914937
Name:ELENITOBA-JOHNSON, BOLANLE (APRN)
Entity type:Individual
Prefix:
First Name:BOLANLE
Middle Name:
Last Name:ELENITOBA-JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 PINELLAS ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3432
Mailing Address - Country:US
Mailing Address - Phone:727-446-2111
Mailing Address - Fax:727-447-2131
Practice Address - Street 1:400 PINELLAS ST STE 220
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3318
Practice Address - Country:US
Practice Address - Phone:727-281-9390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily