Active NPI
Terence Vaughan Connors, PA
- Physician Assistant
- Lake Suzy, FL
National Provider Identifier
1144201351
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 000805
- Practice address
- 12909 SW Pembroke Cir N
Lake Suzy, FL 34269-6937 - Phone
- (941) 255-0770
- NPI assigned
- Nov 7, 2005
- Last updated
- Jun 24, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 000805 | NY | Primary |
Addresses
Primary practice location
12909 SW Pembroke Cir N
Lake Suzy, FL 34269-6937
Mailing address
12909 SW Pembroke Cir N
Lake Suzy, FL 34269-6937
Phone (941) 255-0770
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02347859 | Medicaid | NY | |
| P00012841 | Other | NY | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000805 | NY | MD | Acupuncturist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1466726400000",
"number": "1144201351",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12909 SW PEMBROKE CIR N",
"city": "LAKE SUZY",
"state": "FL",
"postal_code": "342696937",
"telephone_number": "941-255-0770"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12909 SW PEMBROKE CIR N",
"city": "LAKE SUZY",
"state": "FL",
"postal_code": "342696937",
"telephone_number": "941-255-0770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNORS",
"first_name": "TERENCE",
"middle_name": "VAUGHAN",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-07",
"last_updated": "2016-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "000805",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02347859",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00012841",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Suzy, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.