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NPI Code Detail

MEDICARE: OMAR MATTHEW WORRELL ARNP

MEDICARE:   OMAR MATTHEW WORRELL  ARNP
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
1363LF0000XFamily Nurse PractitionerAPRN3420022FL

General Provider Information

NPI Number : 1457886962
Entity Type Code : Individual
Provider Name (Legal Business Name) : OMAR MATTHEW WORRELL ARNP
Provider Business Mailing Address
First Line : 7721 SPRINGFIELD LAKE DR
Second Line :
City : LAKE WORTH
State : FL
Zip : 33467-7892
Country : US
Telephone Number : 561-634-6530
Fax Number :
Provider Business Practice Location Address
First Line : 7721 SPRINGFIELD LAKE DR
Second Line :
City : LAKE WORTH
State : FL
Zip : 33467-7892
Country : US
Telephone Number : 561-634-6530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2017
Last Update Date : 04/23/2017

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