Healthcare Provider Details

I. General information

NPI: 1003975012
Provider Name (Legal Business Name): CHRISTA L O'MARA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 W ASPERA BLVD
GLENDALE AZ
85308-7947
US

IV. Provider business mailing address

2500 W UTOPIA RD STE 100
PHOENIX AZ
85027-4172
US

V. Phone/Fax

Practice location:
  • Phone: 623-248-2108
  • Fax:
Mailing address:
  • Phone: 623-683-4462
  • Fax: 480-882-5814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP11351
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: