Provider Demographics
NPI:1013580471
Name:SILVER, KANDYCE L
Entity Type:Individual
Prefix:MRS
First Name:KANDYCE
Middle Name:L
Last Name:SILVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KANDYCE
Other - Middle Name:L
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:4495 FURLING LN STE 210
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-5423
Mailing Address - Country:US
Mailing Address - Phone:850-460-8483
Mailing Address - Fax:833-645-0014
Practice Address - Street 1:4495 FURLING LN STE 210
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-5423
Practice Address - Country:US
Practice Address - Phone:850-460-8483
Practice Address - Fax:833-645-0014
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1104379363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner