Provider Demographics
NPI:1083292148
Name:MUDDA, CONSTANCE AUDRIANNA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:AUDRIANNA
Last Name:MUDDA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 HAW CREEK MEWS PL
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805-7902
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:157 PARAGON PKWY
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-9463
Practice Address - Country:US
Practice Address - Phone:828-452-6675
Practice Address - Fax:828-356-2062
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMCCA-8ROC7363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily