MEDICARE: MIA ROSE O'MARA PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9112902	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538717806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA ROSE O'MARA PA

Provider Business Mailing Address
First Line	:	151 SOUTHHALL LN STE 300
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-7172
Country	:	US
Telephone Number	:	866-400-3376
Fax Number	:	407-650-3455

Provider Business Practice Location Address
First Line	:	2868 S ALAFAYA TRL STE 130
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32828-7974
Country	:	US
Telephone Number	:	407-770-0063
Fax Number	:	407-770-0129

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	12/15/2025

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Directions to “ MIA ROSE O'MARA PA” Practice Location

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