Basic Information
| Provider Information | |||||||||
| NPI: | 1699789354 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OMEARA | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | MARGARET | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APRN CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 TAMPA GENERAL CIR STE 240 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132583309 | ||||||||
| FaxNumber: | 8132514454 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 TAMPA GENERAL CIR STE 240 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063578 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132583309 | ||||||||
| FaxNumber: | 8132514454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 08/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | APRN1343652 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 034617900 | 05 | FL | MEDICAID |