Provider Demographics
NPI:1124242318
Name:O'CONNOR, KELLY ANN (ARNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 MAITLAND AVE
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4906
Mailing Address - Country:US
Mailing Address - Phone:407-260-9990
Mailing Address - Fax:407-260-9951
Practice Address - Street 1:249 MAITLAND AVE
Practice Address - Street 2:SUITE 1020
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4906
Practice Address - Country:US
Practice Address - Phone:407-260-9990
Practice Address - Fax:407-260-9951
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3030752363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner