Provider Demographics
NPI:1346945953
Name:OMEGA, JAIME JOAQUIN ALIX (NP)
Entity Type:Individual
Prefix:
First Name:JAIME JOAQUIN
Middle Name:ALIX
Last Name:OMEGA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1540 SUNDAY DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6010
Mailing Address - Country:US
Mailing Address - Phone:919-782-3456
Mailing Address - Fax:919-783-1441
Practice Address - Street 1:1540 SUNDAY DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6010
Practice Address - Country:US
Practice Address - Phone:919-782-3456
Practice Address - Fax:919-783-1441
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5017893363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner