Provider Demographics
NPI:1215705421
Name:O'CONNOR, THOMAS JOHN (FNP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 FORT HILL WAY
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3720
Mailing Address - Country:US
Mailing Address - Phone:631-487-1106
Mailing Address - Fax:
Practice Address - Street 1:4741 HIGHWAY 153 STE B
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-9161
Practice Address - Country:US
Practice Address - Phone:888-515-3007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27112363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily