Provider Demographics
NPI:1407307473
Name:HARTGROVE, CONSTANCE
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:
Last Name:HARTGROVE
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 1:5175 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2425
Mailing Address - Country:US
Mailing Address - Phone:614-575-1200
Mailing Address - Fax:614-575-9405
Practice Address - Street 1:5175 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-575-1200
Practice Address - Fax:614-575-9405
Is Sole Proprietor?:No
Enumeration Date:2016-10-14
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF0916863363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily