Provider Demographics
NPI:1932921863
Name:OCONNOR, JODY BAINE
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:BAINE
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 TREMONT GREENS LN
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-8039
Mailing Address - Country:US
Mailing Address - Phone:207-212-2422
Mailing Address - Fax:
Practice Address - Street 1:832 TREMONT GREENS LN
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-8039
Practice Address - Country:US
Practice Address - Phone:207-212-2422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider