Individual
MARILYN GRAY CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
151 SOUTHHALL LN STE 300, MAITLAND, FL 32751-7172
(407) 917-7293
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN11011911
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
120071900
—
FL
01
—
UDET1
BLUE CROSS BLUE SHIELD
FL
Enumeration date
11/23/2020
Last updated
06/17/2024
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