Provider Demographics
NPI:1093131427
Name:CONNOR, BARRY (ARNP)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:CONNOR
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 INGRAHAM AVE
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-4336
Mailing Address - Country:US
Mailing Address - Phone:863-421-6565
Mailing Address - Fax:863-421-7474
Practice Address - Street 1:900 INGRAHAM AVE
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4336
Practice Address - Country:US
Practice Address - Phone:863-421-6565
Practice Address - Fax:863-421-7474
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2753822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily