Provider Demographics
NPI:1083099808
Name:FLORENCE, CONSTANCE
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:FLORENCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 SHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-2872
Mailing Address - Country:US
Mailing Address - Phone:336-501-1430
Mailing Address - Fax:336-623-5001
Practice Address - Street 1:403 SHERWOOD CT
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-2872
Practice Address - Country:US
Practice Address - Phone:336-501-1430
Practice Address - Fax:336-623-5001
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-22
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)