Provider Demographics
NPI:1619112166
Name:COSTANTINI, GWENDOLYN DENISE (DNP, FNPC)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:DENISE
Last Name:COSTANTINI
Suffix:
Gender:F
Credentials:DNP, FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8616 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2042
Mailing Address - Country:US
Mailing Address - Phone:718-805-0037
Mailing Address - Fax:212-420-2483
Practice Address - Street 1:8616 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2042
Practice Address - Country:US
Practice Address - Phone:718-805-0037
Practice Address - Fax:347-960-9468
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF330635363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily