Individual
CONNIE PROSKOVEC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
11715 ORPINGTON ST STE A, TLC PEDIATRIC AND ADOLESCENT MEDICINE IN ASSOC WITH NEM, ORLANDO, FL 32817-4600
(407) 380-9115
(302) 651-4945
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPARTMENT, ROCKLAND, DE 19732-0191
(904) 697-4203
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
3212
OK
208D00000X
General Practice Physician
Primary
OS12811
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014367300
—
FL
05
—
100252200A
—
OK
Enumeration date
06/27/2006
Last updated
05/13/2015
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