Healthcare Provider Details

I. General information

NPI: 1427836220
Provider Name (Legal Business Name): CONSTANCE HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 01/13/2024
Certification Date: 01/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S PENINSULA DR APT 108
DAYTONA BEACH FL
32118-4462
US

IV. Provider business mailing address

102 S PENINSULA DR APT 108
DAYTONA BEACH FL
32118-4462
US

V. Phone/Fax

Practice location:
  • Phone: 386-348-1158
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL I CHRISTIAN
Title or Position: OWNER/ NURSE PRACTITIONER
Credential: APRN
Phone: 386-348-1158