Provider Demographics
NPI:1033147616
Name:O'CONNOR, DIANA (ARNP PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:ARNP PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3744 CYPRESS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2203
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4849 LAKE WORTH RD STE 202
Practice Address - Street 2:SUITE 202
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3462
Practice Address - Country:US
Practice Address - Phone:561-907-7413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2017-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3218222363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45404Medicare ID - Type Unspecified