Provider Demographics
NPI:1205373040
Name:CONSTANTINE, KATIE (COTA)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:CONSTANTINE
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 SW 6TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-1607
Mailing Address - Country:US
Mailing Address - Phone:239-699-1035
Mailing Address - Fax:
Practice Address - Street 1:3502 SW 6TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-1607
Practice Address - Country:US
Practice Address - Phone:239-699-1035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15657314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL806032791OtherTEAMCARE