Provider Demographics
NPI:1447775424
Name:O'CONNOR, TERESA MARY (FNP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARY
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 CONISTON DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2118
Mailing Address - Country:US
Mailing Address - Phone:585-738-1592
Mailing Address - Fax:
Practice Address - Street 1:79 N CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-1407
Practice Address - Country:US
Practice Address - Phone:585-314-7920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF341749363LF0000X
NYF341749-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily