Individual
JULIA O'MALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
214 MORRISON RD, BRANDON, FL 33511-4849
(813) 681-6474
Mailing address
1517 KESTREL WAY, BRANDON, FL 33511-8336
(954) 695-5757
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
9104739
FL
363A00000X
Physician Assistant
PA06250
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800N42
BLUE CROSS BLUE SHIELD
TX
Enumeration date
11/03/2008
Last updated
03/10/2014
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