Provider Demographics
NPI:1053969014
Name:OM, JURRY (FNP)
Entity type:Individual
Prefix:
First Name:JURRY
Middle Name:
Last Name:OM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8880 NAPOLO DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7499
Mailing Address - Country:US
Mailing Address - Phone:303-501-2800
Mailing Address - Fax:
Practice Address - Street 1:707 W EAU GALLIE BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5958
Practice Address - Country:US
Practice Address - Phone:321-727-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMO9002990363LF0000X
COAPN.0994708-NP363LF0000X
FL11032788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily