Provider Demographics
NPI:1043928245
Name:CONSTANTINO, VANESSA RENEE SMITH (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:RENEE SMITH
Last Name:CONSTANTINO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:VANESSA
Other - Middle Name:RENEE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14065 MOONRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-9700
Mailing Address - Country:US
Mailing Address - Phone:951-315-5126
Mailing Address - Fax:
Practice Address - Street 1:25970 IRIS AVE STE 3B
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92551-1660
Practice Address - Country:US
Practice Address - Phone:951-924-2775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95011060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily