Healthcare Provider Details

I. General information

NPI: 1477590321
Provider Name (Legal Business Name): CONNIE LYNN MASSEY A.R.N.P.- B.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CONNIE LYNN NOEL ARNP-BC

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 SPRING HILL DR
SPRING HILL FL
34606-4562
US

IV. Provider business mailing address

15215 CORTEZ BLVD
BROOKSVILLE FL
34613-6072
US

V. Phone/Fax

Practice location:
  • Phone: 352-688-8116
  • Fax: 352-686-9477
Mailing address:
  • Phone: 352-688-8116
  • Fax: 352-686-9477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN7479
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9196681
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: