Healthcare Provider Details

I. General information

NPI: 1659473148
Provider Name (Legal Business Name): JEAN MARY O'CONNOR ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12271 US HIGHWAY 301 N
PARRISH FL
34219-8410
US

IV. Provider business mailing address

PO BOX 499
PARRISH FL
34219-0499
US

V. Phone/Fax

Practice location:
  • Phone: 941-776-4000
  • Fax: 941-776-4057
Mailing address:
  • Phone: 941-776-4000
  • Fax: 941-776-4057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9245432
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: