| Doctor Name: | TANNEH PAULENNA AGBOOLA |
| NPI Number: | 1013318864 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APN |
| License Number: | 26NJ00500900 |
| Business Practice Address: | 1435 Liberty St Hamilton, NJ - 086292220 |
| Business Phone Number: | 6095995433 |
| Business Fax Number: | 6094754662 |
| Mailing Address: | 1435 Liberty St, HAMILTON |
| State: | NJ |
| Postal Code: | 086292220 |
| Phone Number: | 6095995433 |
| Fax Number: | 6094754662 |
| NPI Enumeration Date: | 09/11/2014 |
| NPI Last Update Date: | 09/11/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | 26NJ00500900 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |