Provider Demographics
NPI:1083292148
Name:MUDDA, CONSTANCE AUDRIANNA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:AUDRIANNA
Last Name:MUDDA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-695-6697
Mailing Address - Fax:
Practice Address - Street 1:2400 BOILING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BOILING SPRINGS
Practice Address - State:SC
Practice Address - Zip Code:29316-5304
Practice Address - Country:US
Practice Address - Phone:864-599-0731
Practice Address - Fax:864-599-0791
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMCCA-8ROC7363LF0000X
SC28160363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily