Provider Demographics
NPI:1669010450
Name:CONSTANTINE, DONNA COREEN (DNP)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:COREEN
Last Name:CONSTANTINE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10316 AVENUE L
Mailing Address - Street 2:BROOKLYN
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4534
Mailing Address - Country:US
Mailing Address - Phone:917-952-2898
Mailing Address - Fax:
Practice Address - Street 1:10316 AVENUE L
Practice Address - Street 2:BROOKLYN
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4534
Practice Address - Country:US
Practice Address - Phone:917-952-2898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333181-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY324308OtherRN LICENSE
NYF333181OtherFNP LICENSE