Provider Demographics
NPI:1417998915
Name:CONNOR, TARA (DO)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CONNOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-3720
Mailing Address - Country:US
Mailing Address - Phone:352-344-3777
Mailing Address - Fax:352-344-2546
Practice Address - Street 1:2401 FOREST DR
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3720
Practice Address - Country:US
Practice Address - Phone:352-344-3777
Practice Address - Fax:352-344-2546
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 8408207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262209200Medicaid
FL01084OtherBLUE CROSS & BLUE SHIELD
FL262209200Medicaid
FL01084OtherBLUE CROSS & BLUE SHIELD