Provider Demographics
NPI:1972087518
Name:FLORES, CONNIE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15435 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6113
Mailing Address - Country:US
Mailing Address - Phone:352-796-2909
Mailing Address - Fax:352-796-8196
Practice Address - Street 1:15435 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6113
Practice Address - Country:US
Practice Address - Phone:352-796-2909
Practice Address - Fax:352-796-8196
Is Sole Proprietor?:No
Enumeration Date:2018-09-19
Last Update Date:2024-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113086207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine