Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | ARNP3218222 | FL |
NPI | 1033147616 |
---|---|
Provider Name | Dr. Diana O'connor |
First Address | Lake Worth, FL 33467-2203 |
Second Address | Greenacres, FL 33463-3462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 16/04/2017 |