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General NPI Number Information
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NPI Number | 1245432111
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Entity Type | Organization
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Legal Business Name | TARA CONNOR DO PA
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 2401 FOREST DR
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City | INVERNESS
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State | FL
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Zip | 34453-3720
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Country | US
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Telephone | 352-344-3777
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Fax | 352-344-2546
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Provider Business Mailing Address
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Address Line | 2401 FOREST DR
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City | INVERNESS
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State | FL
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Zip | 34453-3720
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Country | US
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Telephone | 352-344-3777
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Fax | 352-344-2546
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Authorized Official
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Title or Position | PRESIDENT PHYSICIAN
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Name | TARA CONNOR
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Credential | DO
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Telephone | 352-344-3777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS8408
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License Number State | FL
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