Individual provider Active NPI

Jordan Nicole O'Connor, PA-C

  • Physician Assistant
  • Lithia, FL
National Provider Identifier
1255962650
Registry record updated Oct 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9113291 Issued in FL
Practice address
13837 Circa Crossing Dr
Lithia, FL 33547-4382
Phone
(813) 684-2663
Fax
(813) 658-6222
NPI assigned
Feb 4, 2020
Last updated
Oct 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9113291 FL Primary

Addresses

Primary practice location

13837 Circa Crossing Dr
Lithia, FL 33547-4382

Mailing address

13837 Circa Crossing Dr
Lithia, FL 33547-4382
Phone (813) 684-2663

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
I20210225000214 FL Practitioner - Physician Assistant 2365857323 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13837 Circa Crossing Dr
Lithia, FL 33547-4382
Phone (813) 535-6647

400 Ave K SE
Suite 4
Winter Haven, FL 33880-4123
Phone (813) 684-2663

414 N Plant Ave
Plant City, FL 33563-7248
Phone (813) 684-2663

420 N Plant Ave
Plant City, FL 33563-7248
Phone (813) 684-2663

4541 S Dale Mabry Hwy
Suite 200
Tampa, FL 33611-1407
Phone (813) 684-2663

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 1

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": "1580774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1255962650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13837 CIRCA CROSSING DR",
            "city": "LITHIA",
            "state": "FL",
            "postal_code": "335474382",
            "telephone_number": "813-684-2663",
            "fax_number": "813-658-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13837 CIRCA CROSSING DR",
            "city": "LITHIA",
            "state": "FL",
            "postal_code": "335474382",
            "telephone_number": "813-684-2663",
            "fax_number": "813-658-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNOR",
        "first_name": "JORDAN",
        "middle_name": "NICOLE",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-02-04",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9113291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lithia, FL

Sources for this page

Verify at the official NPI Registry.