Provider Demographics
NPI:1508100678
Name:MCGOVERN, CONSTANCE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2567 SE 7TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5211
Mailing Address - Country:US
Mailing Address - Phone:305-230-9884
Mailing Address - Fax:305-230-6178
Practice Address - Street 1:2567 SE 7TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-5211
Practice Address - Country:US
Practice Address - Phone:305-230-9884
Practice Address - Fax:305-230-6178
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1078492163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse