Basic Information
| Provider Information | |||||||||
| NPI: | 1659473148 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'CONNOR | ||||||||
| FirstName: | JEAN | ||||||||
| MiddleName: | MARY | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 499 | ||||||||
| Address2: | |||||||||
| City: | PARRISH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342190499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417764000 | ||||||||
| FaxNumber: | 9417764057 | ||||||||
| Practice Location | |||||||||
| Address1: | 12271 US HIGHWAY 301 N | ||||||||
| Address2: | |||||||||
| City: | PARRISH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342198410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417764000 | ||||||||
| FaxNumber: | 9417764057 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2006 | ||||||||
| LastUpdateDate: | 01/23/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9245432 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | ARNP245432 | 01 | FL | PROFESSIONAL LICENSE | OTHER |