Provider Demographics
NPI:1700776176
Name:FOSTER, CONNIE RAE (PMNNP-BC)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:RAE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PMNNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1074 ALADDIN RD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-6406
Mailing Address - Country:US
Mailing Address - Phone:352-303-7451
Mailing Address - Fax:
Practice Address - Street 1:1100 CLEARWATER LARGO RD N
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-4131
Practice Address - Country:US
Practice Address - Phone:727-518-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11040714363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health