MEDICARE: CONNIE LOUANN PHILLIP FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	22232	SC

General Provider Information

NPI Number	:	1720562416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE LOUANN PHILLIP FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 751461
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1461
Country	:	US
Telephone Number	:	888-472-0043
Fax Number	:	843-724-2440

Provider Business Practice Location Address
First Line	:	3575 MAYBANK HWY STE A
Second Line	:
City	:	JOHNS ISLAND
State	:	SC
Zip	:	29455-4871
Country	:	US
Telephone Number	:	843-402-1870
Fax Number	:	843-203-2241

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2018
Last Update Date	:	08/04/2025

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