Provider Demographics
NPI:1053047928
Name:OMELIA, MICHELLE ENID FERREIRA (MSN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ENID FERREIRA
Last Name:OMELIA
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ENID
Other - Last Name:FERREIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5851 TIMUQUANA RD STE 201
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-7898
Mailing Address - Country:US
Mailing Address - Phone:904-779-2220
Mailing Address - Fax:904-739-1302
Practice Address - Street 1:5851 TIMUQUANA RD STE 201
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-7898
Practice Address - Country:US
Practice Address - Phone:904-737-6313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020372363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner