Healthcare Provider Details

I. General information

NPI: 1083712418
Provider Name (Legal Business Name): CAROLYN SCHROEDER CONNELLY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 W SWANN AVE STE 404
TAMPA FL
33609-4052
US

IV. Provider business mailing address

2919 W SWANN AVE STE 404
TAMPA FL
33609-4052
US

V. Phone/Fax

Practice location:
  • Phone: 813-870-2100
  • Fax: 813-870-2125
Mailing address:
  • Phone: 813-870-2100
  • Fax: 813-870-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number51168
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: