OMAR WAZZAN (NPI# 1093255952) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093255952 |
| Entity Type | Individual |
| Full Name | OMAR WAZZAN |
| Practice Address |
130 Pablo St Lakeland FL 33803-3818 |
| Mailing Address |
1324 Lakeland Hills Blvd Managed Care Dept Tampa FL 33647-4055 |
| Practice Telephone | 8632845906 |
| Practice Fax Number | 8632845149 |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2020-03-13 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
ME127244 | FL | Allopathic & Osteopathic Physicians |
| Street Address |
130 PABLO ST |
| City | LAKELAND |
| State | FL |
| Zip Code | 33803-3818 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003810672 | Andrea Beale | Nurse Practitioner | 130 Pablo St, Lakeland, FL 33803-3818 | 2005-06-10 |
| 1740804673 | Brian Win | Physician Assistant | 130 Pablo St, Lakeland, FL 33803-3818 | 2020-06-06 |
| 1285284216 | Sandra Baffoe-bonnie | Nurse Practitioner | 130 Pablo St, Lakeland, FL 33803-3818 | 2019-09-11 |
| 1215586458 | Jillian Railey | Nurse Practitioner | 130 Pablo St, Lakeland, FL 33803-3818 | 2019-09-10 |
| 1194384362 | Ellen Davis | Physician Assistant | 130 Pablo St, Lakeland, FL 33803-3818 | 2019-06-11 |
| 1558827592 | Rebecca N Levine | Physician Assistant | 130 Pablo St, Lakeland, FL 33803-3818 | 2019-02-14 |
| 1124594007 | Rany Najeh Ahmad | Nurse Practitioner | 130 Pablo St, Lakeland, FL 33803-3818 | 2018-10-18 |
| 1093224206 | Moezza Butler | Registered Nurse | 130 Pablo St, Lakeland, FL 33803-3818 | 2017-09-20 |
| 1679092050 | Jessica Polk | Internal Medicine | 130 Pablo St, Lakeland, FL 33803-3818 | 2017-09-16 |
| 1750803201 | Mary L Roy | Nurse Practitioner | 130 Pablo St, Lakeland, FL 33803-3818 | 2017-07-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861964819 | Steven P Agelidis | Counselor | 2020 S. Florida Ave, Suite 207, Lakeland, FL 33803 | 2018-12-31 |
| 1902316201 | Kesara Mai Ngam | Massage Therapist | 117 West Oak Drive, Lakeland, FL 33803 | 2017-10-02 |
| 1396260618 | Suncoast Behavioral Solutions, LLC | Behavioral Analyst | 1920 E Edgewood Dr Apt A8, Lakeland, FL 33803 | 2017-08-08 |
| 1316484413 | Daniel Jacob Stahl | Behavior Technician | 145 East Edgewood Drive, Lakeland, FL 33803 | 2017-01-26 |
| 1780037002 | Shelley Stettinius | Behavioral Analyst | 145 East Edgewood Dr, Lakeland, FL 33803 | 2016-07-21 |
| 1396106654 | Highlands Occupational Therapy, Inc | Occupational Therapist | 2000 East Edgewood Drive, Suite 114, Lakeland, FL 33803 | 2016-03-15 |
| 1003289570 | Jayna Dinsmore | Physical Therapy Assistant | 321 Imperial Blvd, D38, Lakeland, FL 33803 | 2015-11-05 |
| 1093187429 | Healthstat Wellness Polk-lakeland | Preventive Medicine | 3215 Winter Lake Road, Lakeland, FL 33803 | 2015-10-26 |
| 1962812545 | Florida Presbyterian Homes, Inc | Nursing Facility/Intermediate Care Facility | 901 Lakeside Avenue, Lakeland, FL 33803 | 2014-05-05 |
| 1710316336 | Trinity Endodontics | Health Maintenance Organization | 1602 S. Florida Ave, Ste #1, Lakeland, FL 33803 | 2013-11-04 |
| Find all providers in zip 33803 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548237902 | Josephine Blanche Lim | Psychiatry & Neurology | 2404 Lakeland Hills Blvd, Lakeland, FL 33805 | 2006-03-03 |
| 1215927371 | Herminio Cuervo-delgado | Psychiatry & Neurology | 1601 Williamsburg Sq, Lakeland, FL 33803-4279 | 2005-10-28 |
| 1255702809 | Fausto Edgardo Ordonez | Psychiatry & Neurology | 1600 Lakeland Hills Blvd, Lakeland, FL 33805-3019 | 2015-10-08 |
| 1871814822 | Daynet Hisley | Psychiatry & Neurology | 1600 Lakeland Hills Blvd, Lakeland, FL 33805-3019 | 2010-06-14 |
| 1619108354 | Kewei Yu | Psychiatry & Neurology | 5050 S Florida Ave, Lakeland, FL 33813-2501 | 2009-07-29 |
| 1679733364 | Gabriel Pantol | Psychiatry & Neurology | 1600 Lakeland Hills Blvd, Lakeland, FL 33805-3019 | 2008-06-16 |
| 1295911196 | Josephine B Lim Md Pa | Psychiatry & Neurology | 2404 Lakeland Hills Blvd, Lakeland, FL 33805-2214 | 2008-01-10 |
| 1578616371 | Herminio Cuervo Md Pa | Psychiatry & Neurology | 1601 Williamsburg Sq, Lakeland, FL 33803-4279 | 2007-01-18 |
| 1962444372 | Florida Neurology Institute | Psychiatry & Neurology | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2006-06-11 |
| 1871545921 | Tarek Farouk Bakdash | Psychiatry & Neurology | 1600 Lakeland Hills Blvd, Lakeland, FL 33805 | 2006-05-17 |
| Find all providers in LAKELAND | ||||
Please comment or provide details below to improve the information on OMAR WAZZAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.