MEDICARE: VERONICA O'CONNOR

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	363AM0700X	Medical Physician Assistant	PA2677	FL

General Provider Information

NPI Number	:	1871824771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONICA O'CONNOR

Provider Business Mailing Address
First Line	:	22031 ALTONA DR
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-4771
Country	:	US
Telephone Number	:	561-883-9724
Fax Number	:	954-321-9660

Provider Business Practice Location Address
First Line	:	1330 RIVERLAND RD
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-2961
Country	:	US
Telephone Number	:	954-321-9826
Fax Number	:	954-321-9660

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

Provider Enumeration Date	:	01/18/2010
Last Update Date	:	01/18/2010

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