Provider Demographics
NPI:1891867743
Name:CALLAHAN, CONNIE EDGIL (ARNP)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:EDGIL
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:CONNIE
Other - Middle Name:EDGIL
Other - Last Name:MCINTOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:209 SW CALLAHAN AVE.
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-4213
Mailing Address - Country:US
Mailing Address - Phone:386-697-6251
Mailing Address - Fax:
Practice Address - Street 1:619 S MARION AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-5808
Practice Address - Country:US
Practice Address - Phone:386-754-6412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9249931163W00000X
TNRN0000140269163W00000X
TNAPN0000008429363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner