Healthcare Provider Details

I. General information

NPI: 1285037051
Provider Name (Legal Business Name): CONSTANCE SMITH CPNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 CYPRESS SPRINGS DR
ARLINGTON TX
76001-5104
US

IV. Provider business mailing address

4205 CYPRESS SPRINGS DR
ARLINGTON TX
76001-5104
US

V. Phone/Fax

Practice location:
  • Phone: 817-478-4674
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP125494
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: