Healthcare Provider Details

I. General information

NPI: 1043201411
Provider Name (Legal Business Name): TRACEY LYNN O'CONNOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DR
TAMPA FL
33612-9416
US

IV. Provider business mailing address

12902 USF MAGNOLIA DR
TAMPA FL
33612-9416
US

V. Phone/Fax

Practice location:
  • Phone: 813-745-8000
  • Fax:
Mailing address:
  • Phone: 813-745-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number215895
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME163139
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: