Provider Demographics
NPI:1417939588
Name:CONNOR, NADINE EDWARDA (DNP, MSN, APRN, BC)
Entity type:Individual
Prefix:DR
First Name:NADINE
Middle Name:EDWARDA
Last Name:CONNOR
Suffix:
Gender:
Credentials:DNP, MSN, APRN, BC
Other - Prefix:MS
Other - First Name:NADINE
Other - Middle Name:EDWARDA
Other - Last Name:THOMSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NADINE LOMBARD
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:PORTAGE LAKE
Mailing Address - State:ME
Mailing Address - Zip Code:04768-0108
Mailing Address - Country:US
Mailing Address - Phone:813-943-5042
Mailing Address - Fax:
Practice Address - Street 1:208 WEST RD
Practice Address - Street 2:
Practice Address - City:PORTAGE LAKE
Practice Address - State:ME
Practice Address - Zip Code:04768-8801
Practice Address - Country:US
Practice Address - Phone:813-943-5042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP221279363LF0000X
FLARNP9247643363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020124400Medicaid
FL020124400Medicaid