Provider Demographics
NPI:1245906064
Name:MCCONNELL, DEE ALEXANDRA (NP)
Entity type:Individual
Prefix:MISS
First Name:DEE
Middle Name:ALEXANDRA
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2140 KINGSLEY AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5129
Mailing Address - Country:US
Mailing Address - Phone:904-213-0652
Mailing Address - Fax:
Practice Address - Street 1:2140 KINGSLEY AVE STE 15
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5129
Practice Address - Country:US
Practice Address - Phone:904-213-0652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR247873363LF0000X
FLAPRN11018933363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR247873OtherMARYLAND BOARD OF NURSING
FLAPRN11018933OtherFLORIDA BOARD OF NURSING