Provider Demographics
NPI:1043636244
Name:HARRIS, CANDACE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:DAWN
Other - Last Name:EDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1204 W POPLAR AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-3103
Mailing Address - Country:US
Mailing Address - Phone:901-610-3135
Mailing Address - Fax:
Practice Address - Street 1:1204 W POPLAR AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-3103
Practice Address - Country:US
Practice Address - Phone:901-610-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily