Provider Demographics
NPI:1417939588
Name:CONNOR, NADINE EDWARDA (RN, MSN, APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:NADINE
Middle Name:EDWARDA
Last Name:CONNOR
Suffix:
Gender:F
Credentials:RN, MSN, APRN, BC
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:EDWARDA
Other - Last Name:THOMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4440 FRUITVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-1926
Mailing Address - Country:US
Mailing Address - Phone:941-300-4440
Mailing Address - Fax:941-404-1760
Practice Address - Street 1:1315 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33605-3605
Practice Address - Country:US
Practice Address - Phone:813-769-7207
Practice Address - Fax:844-722-0028
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9247643363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020124400Medicaid
FL020124400Medicaid