Provider Demographics
NPI:1487292165
Name:OMAI, PRISCILLA E (APRN)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:E
Last Name:OMAI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 NE 163RD ST STE 26
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4528
Mailing Address - Country:US
Mailing Address - Phone:786-489-8111
Mailing Address - Fax:
Practice Address - Street 1:1140 NE 163RD ST STE 26
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4528
Practice Address - Country:US
Practice Address - Phone:786-489-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11005214363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health