Provider Demographics
NPI:1912194325
Name:OMAR, NADIA N (PA)
Entity Type:Individual
Prefix:
First Name:NADIA
Middle Name:N
Last Name:OMAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 W 76TH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-3885
Mailing Address - Country:US
Mailing Address - Phone:305-233-3603
Mailing Address - Fax:
Practice Address - Street 1:3141 W 76TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-3885
Practice Address - Country:US
Practice Address - Phone:305-233-3603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-29
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103982363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant