Provider Demographics
NPI:1659473148
Name:O'CONNOR, JEAN MARY (ARNP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARY
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 499
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-0499
Mailing Address - Country:US
Mailing Address - Phone:941-776-4000
Mailing Address - Fax:941-776-4057
Practice Address - Street 1:12271 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-8410
Practice Address - Country:US
Practice Address - Phone:941-776-4000
Practice Address - Fax:941-776-4057
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9245432363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP245432OtherPROFESSIONAL LICENSE