Provider Demographics
NPI:1427189695
Name:BUMILLER, CONSTANCE ANN (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:CONSTANCE
Middle Name:ANN
Last Name:BUMILLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 BELFORT RD
Mailing Address - Street 2:STE 130
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6017
Mailing Address - Country:US
Mailing Address - Phone:727-867-5480
Mailing Address - Fax:888-507-9833
Practice Address - Street 1:7939 HARWOOD RD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-3102
Practice Address - Country:US
Practice Address - Phone:727-432-3449
Practice Address - Fax:727-397-0718
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2685832363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308215600Medicaid
FLY114AOtherBCBS
FLY114AOtherBCBS
FL308215600Medicaid