Healthcare Provider Details

I. General information

NPI: 1750954046
Provider Name (Legal Business Name): CONSTANCE GRACE COMPTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1443 SAN MARCO BLVD STE 101
JACKSONVILLE FL
32207-8535
US

IV. Provider business mailing address

1443 SAN MARCO BLVD STE 101
JACKSONVILLE FL
32207-8535
US

V. Phone/Fax

Practice location:
  • Phone: 904-253-6910
  • Fax: 904-253-6964
Mailing address:
  • Phone: 904-253-6910
  • Fax: 904-253-6964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number11014160
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: