Healthcare Provider Details

I. General information

NPI: 1124162995
Provider Name (Legal Business Name): PAMELA A HOMER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA A OSELES-MAST

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 CEDAR ST
ROCKLEDGE FL
32955-3133
US

IV. Provider business mailing address

400 E SHERIDAN RD
MELBOURNE FL
32901-3184
US

V. Phone/Fax

Practice location:
  • Phone: 321-890-1500
  • Fax:
Mailing address:
  • Phone: 321-722-5273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number99914
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0995760
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0995760
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: