Provider Demographics
NPI:1265921290
Name:PROTENTIS, CONSTANCE VICTORIA (PA-C)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:VICTORIA
Last Name:PROTENTIS
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1820 STATE ROUTE 33
Mailing Address - Street 2:STE 4B
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4860
Mailing Address - Country:US
Mailing Address - Phone:732-776-8500
Mailing Address - Fax:732-776-8946
Practice Address - Street 1:1820 STATE ROUTE 33 STE 4B
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-776-8500
Practice Address - Fax:732-776-8946
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00473500363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical