MEDICARE: CAROLINE O'CONNOR RD, LD

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
1	133V00000X	Registered Dietitian	ND9438	FL

General Provider Information

NPI Number	:	1063006898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE O'CONNOR RD, LD

Provider Business Mailing Address
First Line	:	1910 E PALM AVE APT 9102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-3827
Country	:	US
Telephone Number	:	614-824-7568
Fax Number	:

Provider Business Practice Location Address
First Line	:	1910 E PALM AVE APT 9102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-3827
Country	:	US
Telephone Number	:	614-824-7568
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/23/2021
Last Update Date	:	02/23/2021

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