Provider Demographics
NPI:1316047129
Name:WULF, CONSTANCE MARIE (AP)
Entity type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:MARIE
Last Name:WULF
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000A SAWGRASS VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-5011
Mailing Address - Country:US
Mailing Address - Phone:904-994-3709
Mailing Address - Fax:904-247-9366
Practice Address - Street 1:6000A SAWGRASS VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-5011
Practice Address - Country:US
Practice Address - Phone:904-994-3709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2279171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP2279OtherACUPUNCTURE