Healthcare Provider Details

I. General information

NPI: 1730730250
Provider Name (Legal Business Name): CIARA O'CONNOR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2019
Last Update Date: 07/19/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 UNIVERSITY PKWY STE 219
SARASOTA FL
34243-2809
US

IV. Provider business mailing address

8463 KARPEAL DR
SARASOTA FL
34238-5725
US

V. Phone/Fax

Practice location:
  • Phone: 941-413-0834
  • Fax:
Mailing address:
  • Phone: 773-551-3925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9112563
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: