Provider Demographics
NPI:1942918941
Name:MCCONNELL, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 HIGHWAY 17
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8245
Mailing Address - Country:US
Mailing Address - Phone:904-264-4333
Mailing Address - Fax:904-264-4301
Practice Address - Street 1:4611 HIGHWAY 17
Practice Address - Street 2:SUITE 2
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003
Practice Address - Country:US
Practice Address - Phone:904-264-4333
Practice Address - Fax:904-264-4301
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027258363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics