Provider Demographics
NPI:1801456413
Name:CONSTANTIN, KAITLIN BROOKE (ARNP)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:BROOKE
Last Name:CONSTANTIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5282 HIDDEN HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-1820
Mailing Address - Country:US
Mailing Address - Phone:904-607-4302
Mailing Address - Fax:
Practice Address - Street 1:5282 HIDDEN HOLLOW CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-1820
Practice Address - Country:US
Practice Address - Phone:904-607-4302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily