Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | ARNP 9229531 | FL |
NPI | 1003162256 |
---|---|
Provider Name | Mindy Connors |
First Address | Brandon, FL 33511-5908 |
Second Address | Brandon, FL 33511-5908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2012 |
Last Update Date | 21/01/2016 |