Provider Demographics
NPI:1831167600
Name:CONNORS, CATHALEEN ANN (CNA)
Entity type:Individual
Prefix:MS
First Name:CATHALEEN
Middle Name:ANN
Last Name:CONNORS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 JUNIPER DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141-6209
Mailing Address - Country:US
Mailing Address - Phone:386-428-0677
Mailing Address - Fax:386-428-0677
Practice Address - Street 1:3131 JUNIPER DR
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32141-6209
Practice Address - Country:US
Practice Address - Phone:386-428-0677
Practice Address - Fax:386-428-0677
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2013-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 49161171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6892329 79Medicaid