Provider Demographics
NPI:1952595332
Name:FRAATZ, CONSTANCE GRACE (DOM/AP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:GRACE
Last Name:FRAATZ
Suffix:
Gender:F
Credentials:DOM/AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 LOOKOUT PL
Mailing Address - Street 2:SUITE 209
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4485
Mailing Address - Country:US
Mailing Address - Phone:407-772-9243
Mailing Address - Fax:407-772-9245
Practice Address - Street 1:260 LOOKOUT PL
Practice Address - Street 2:SUITE 209
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4485
Practice Address - Country:US
Practice Address - Phone:407-772-9243
Practice Address - Fax:407-772-9245
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2336171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist