Provider Demographics
NPI:1902321151
Name:EGBOH, MAUREEN (ARNP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:EGBOH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 PARK AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1048
Mailing Address - Country:US
Mailing Address - Phone:215-536-0655
Mailing Address - Fax:267-517-9030
Practice Address - Street 1:7200 CAMINO REAL STE 300
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-5511
Practice Address - Country:US
Practice Address - Phone:561-487-4110
Practice Address - Fax:561-487-2939
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9361744363LF0000X
PASP018326363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN9361744OtherAPRN