Healthcare Provider Details

I. General information

NPI: 1598984114
Provider Name (Legal Business Name): CONSTANCE M MIX R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 TAMIAMI TRL E BUILDING H
NAPLES FL
34112-3969
US

IV. Provider business mailing address

PO BOX 429
NAPLES FL
34106-0429
US

V. Phone/Fax

Practice location:
  • Phone: 239-732-2697
  • Fax: 239-774-5653
Mailing address:
  • Phone: 239-732-2697
  • Fax: 239-774-5653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN9170667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: