Provider Demographics
NPI:1609914076
Name:CONNER, COLIN L (RN, MS, PNP-BC,CNS)
Entity Type:Individual
Prefix:MR
First Name:COLIN
Middle Name:L
Last Name:CONNER
Suffix:
Gender:M
Credentials:RN, MS, PNP-BC,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 E CAMBRIDGE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-1464
Mailing Address - Country:US
Mailing Address - Phone:602-689-8684
Mailing Address - Fax:602-256-2878
Practice Address - Street 1:1920 E CAMBRIDGE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1459
Practice Address - Country:US
Practice Address - Phone:602-689-8684
Practice Address - Fax:602-256-2878
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX561332364SP0200X
AZRN052285364SP0200X
AZAP3833363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics