Healthcare Provider Details

I. General information

NPI: 1518700301
Provider Name (Legal Business Name): JENNIFER A OMEAL AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13677 W MCDOWELL RD
GOODYEAR AZ
85395-2635
US

IV. Provider business mailing address

18623 W SUNNYSLOPE LN
WADDELL AZ
85355-4415
US

V. Phone/Fax

Practice location:
  • Phone: 623-882-1500
  • Fax:
Mailing address:
  • Phone: 623-326-8923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number109079
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number109079
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: