Healthcare Provider Details

I. General information

NPI: 1427189695
Provider Name (Legal Business Name): CONSTANCE ANN BUMILLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7939 HARWOOD RD
SEMINOLE FL
33777-3102
US

IV. Provider business mailing address

5220 BELFORT RD STE 130
JACKSONVILLE FL
32256-6017
US

V. Phone/Fax

Practice location:
  • Phone: 727-432-3449
  • Fax: 727-397-0718
Mailing address:
  • Phone: 727-867-5480
  • Fax: 888-507-9833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2685832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: