Individual provider Active NPI

Nicole O'Connor, AGPCNP

  • Nurse Practitioner
  • Ruskin, FL
National Provider Identifier
1043681117
Registry record updated Jun 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
AG1015006 Issued in FL
Practice address
10113 Count Fleet Dr
Ruskin, FL 33573-6772
Phone
(813) 362-9588
NPI assigned
Oct 14, 2015
Last updated
Jun 9, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X AG1015006 FL Primary

Addresses

Primary practice location

10113 Count Fleet Dr
Ruskin, FL 33573-6772

Mailing address

10113 Count Fleet Dr
Ruskin, FL 33573-6772
Phone (813) 362-9588

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address noconnor155398@direct.tgh.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160422002031 FL Practitioner - Nurse Practitioner 6103125281 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tampa General Medical Group IncGroup PAC ID 7416253828, 353 clinicians

Practice addresses (Care Compare)

409 Bayshore Blvd
Tampa, FL 33606-2707
Phone (813) 844-9302

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AG1015006FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tampa General Medical Group Inc CurrentSince May 13, 2019 Accepting new patients
Tampa General Hospital Current Accepting new patients
Tampa General Medical Group Inc CurrentSince May 13, 2019 Accepting new patients
Tampa General Medical Group Inc Past Accepting new patients

Locations

214 Morrison Rd
Ste 110
Brandon, FL 33511
Phone (800) 844-9302

409 Bayshore Blvd
Tampa, FL 33606
Phone (813) 253-2640

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • FHIR API: https://epicproxy.et0761.epichosted.com/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: noconnor155398@direct.tgh.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623196800000",
    "number": "1043681117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10113 COUNT FLEET DR",
            "city": "RUSKIN",
            "state": "FL",
            "postal_code": "335736772",
            "telephone_number": "813-362-9588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10113 COUNT FLEET DR",
            "city": "RUSKIN",
            "state": "FL",
            "postal_code": "335736772",
            "telephone_number": "813-362-9588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNOR",
        "first_name": "NICOLE",
        "credential": "AGPCNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-14",
        "last_updated": "2021-06-09",
        "certification_date": "2021-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "AG1015006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "noconnor155398@direct.tgh.org",
            "affiliation": "N",
            "address_1": "409 Bayshore Blvd",
            "city": "Tampa",
            "state": "FL",
            "country_code": "US",
            "postal_code": "336062707",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Ruskin, FL

Sources for this page

Verify at the official NPI Registry.