Provider Demographics
NPI:1477590321
Name:MASSEY, CONNIE LYNN (ARNP- BC)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:LYNN
Last Name:MASSEY
Suffix:
Gender:F
Credentials:ARNP- BC
Other - Prefix:MRS
Other - First Name:CONNIE
Other - Middle Name:LYNN
Other - Last Name:NOEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP-BC
Mailing Address - Street 1:15215 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6072
Mailing Address - Country:US
Mailing Address - Phone:352-688-8116
Mailing Address - Fax:352-686-9477
Practice Address - Street 1:5350 SPRING HILL DR
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-4562
Practice Address - Country:US
Practice Address - Phone:352-688-8116
Practice Address - Fax:352-686-9477
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7479363LF0000X
FL9196681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0448XMedicare PIN
P23379Medicare UPIN
3644026Medicare PIN