Provider Demographics
NPI:1679365043
Name:OMOSO, CHRISTINA (CNA)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:
Last Name:OMOSO
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 UNIVERSITY CLUB BLVD N APT 229
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-9435
Mailing Address - Country:US
Mailing Address - Phone:904-916-4741
Mailing Address - Fax:
Practice Address - Street 1:5501 UNIVERSITY CLUB BLVD N APT 229
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-9435
Practice Address - Country:US
Practice Address - Phone:904-916-4741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide