Provider Demographics
NPI:1831828805
Name:FOX, CONNIE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 DOLPHIN DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-7356
Mailing Address - Country:US
Mailing Address - Phone:407-844-2331
Mailing Address - Fax:
Practice Address - Street 1:8751 N 30TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-2213
Practice Address - Country:US
Practice Address - Phone:813-980-2422
Practice Address - Fax:813-305-2642
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty