Provider Demographics
NPI:1528414638
Name:OMMEN, SIJI (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SIJI
Middle Name:
Last Name:OMMEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18600 SW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-6132
Mailing Address - Country:US
Mailing Address - Phone:786-382-1218
Mailing Address - Fax:
Practice Address - Street 1:18600 SW 16TH ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-6132
Practice Address - Country:US
Practice Address - Phone:786-382-1218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9243268163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice