Healthcare Provider Details

I. General information

NPI: 1710677497
Provider Name (Legal Business Name): JESSIE CONSTANT DNP, CMN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 SW 172ND AVE
MIRAMAR FL
33029-5593
US

IV. Provider business mailing address

4317 SW 175TH AVE
MIRAMAR FL
33029-1601
US

V. Phone/Fax

Practice location:
  • Phone: 954-507-4494
  • Fax:
Mailing address:
  • Phone: 305-297-9229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11021627
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: