Healthcare Provider Details

I. General information

NPI: 1043776636
Provider Name (Legal Business Name): GINA O'CONNOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 S ORANGE AVE STE 200
ORLANDO FL
32806-2932
US

IV. Provider business mailing address

1720 S ORANGE AVE STE 200
ORLANDO FL
32806-2932
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-1425
  • Fax: 321-843-1478
Mailing address:
  • Phone: 321-843-1425
  • Fax: 321-843-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9191628
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: