Provider Demographics
NPI:1619416328
Name:HARGROVE, CONSTANCE (APRN)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:HARGROVE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1492 TROPICAL PINE CV STE 2
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-9119
Mailing Address - Country:US
Mailing Address - Phone:352-871-2779
Mailing Address - Fax:
Practice Address - Street 1:1492 TROPICAL PINE CV STE 2
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-9119
Practice Address - Country:US
Practice Address - Phone:352-871-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9312081363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology