Healthcare Provider Details

I. General information

NPI: 1114312907
Provider Name (Legal Business Name): JESSICA ELIZABETH OMARA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 SHERIDAN ST
HOLLYWOOD FL
33021-3516
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 954-966-8000
  • Fax: 954-966-6614
Mailing address:
  • Phone: 954-966-8000
  • Fax: 954-966-6614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME168839
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number294509-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: