Active NPI
Connie D Micklavzina, MD
- Obstetrics & Gynecology Physician
- Sarasota, FL
National Provider Identifier
1487725701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- ME47350
- Practice address
- 2200 Ringling Blvd
Sarasota, FL 34237-6102 - Phone
- (941) 861-2900
- Fax
- (941) 861-2828
- NPI assigned
- Nov 10, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | ME47350 | FL | Primary |
Addresses
Primary practice location
2200 Ringling Blvd
Sarasota, FL 34237-6102
Mailing address
2200 Ringling Blvd
Sarasota, FL 34237-6102
Phone (941) 861-2900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 046022200 | Medicaid | FL |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME47350 | FL | MD | Obstetrics & Gynecology Physician |
Networks
- Optimum HealthCare HMO Network
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163116800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360195200000",
"number": "1487725701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2200 RINGLING BLVD",
"city": "SARASOTA",
"state": "FL",
"postal_code": "342376102",
"telephone_number": "941-861-2900",
"fax_number": "941-861-2828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2200 RINGLING BLVD",
"city": "SARASOTA",
"state": "FL",
"postal_code": "342376102",
"telephone_number": "941-861-2900",
"fax_number": "941-861-2828"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICKLAVZINA",
"first_name": "CONNIE",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-10",
"last_updated": "2013-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "FL",
"license": "ME47350",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "046022200",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sarasota, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.