Provider Demographics
NPI:1063006898
Name:O'CONNOR, CAROLINE (RD, LD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 E PALM AVE APT 9102
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33605-3827
Mailing Address - Country:US
Mailing Address - Phone:614-824-7568
Mailing Address - Fax:
Practice Address - Street 1:1910 E PALM AVE APT 9102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-3827
Practice Address - Country:US
Practice Address - Phone:614-824-7568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND9438133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered