Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Abimbola Datonye Iketubosin, FNP

Individual provider Family Nurse Practitioner · NPI 1356841514

Abimbola Datonye Iketubosin, FNP is a Nurse Practitioner in Phoenix, Arizona. Qualified in 2020, 6 years ago. Practices with Clinica Sierra Vista, a 184-clinician group and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
6
Licensed in
AZ
In the registry since
2018
Specialties on file
3
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

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Practice location Address checks out

4212 N 16th St
Phoenix, AZ 85016-5319
Phone: (602) 263-1200
Fax: (602) 263-1619
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 221449 (AZ)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence F08180855 (AZ)
General Practice Registered Nurse Taxonomy 163WG0000X · Licence 221449 (AZ)

Record details

NPI number1356841514
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP
Sole proprietorNo
NPI enumeratedFebruary 14, 2018
Last updated in NPPESDecember 15, 2025
Certification dateDecember 15, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Clinica Sierra Vista — 184 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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