Provider Demographics
NPI:1841282373
Name:CARMODY, CONSTANCE B (ARNP)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:B
Last Name:CARMODY
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 1:3156 CRAYTON RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4056
Mailing Address - Country:US
Mailing Address - Phone:239-262-1260
Mailing Address - Fax:239-262-2429
Practice Address - Street 1:1095 WHIPPOORWILL LN
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-3847
Practice Address - Country:US
Practice Address - Phone:239-261-4404
Practice Address - Fax:239-262-2429
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9164317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY060BOtherBLUE CROSS BLUE SHIELD OF
FLY060BOtherBLUE CROSS BLUE SHIELD OF