Provider Demographics
NPI:1205980505
Name:CUSTER, CONSTANCE (RNFA)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:
Last Name:CUSTER
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23007
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33307-3007
Mailing Address - Country:US
Mailing Address - Phone:954-227-8224
Mailing Address - Fax:954-227-7442
Practice Address - Street 1:119 NE 19TH CT
Practice Address - Street 2:UNIT G-118
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1043
Practice Address - Country:US
Practice Address - Phone:954-873-4822
Practice Address - Fax:954-390-0420
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1698912163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant