Provider Demographics
NPI:1073079992
Name:FUNG, CANDACE CHRISTINA (NP-C)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:CHRISTINA
Last Name:FUNG
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 COPPERSTONE LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-5595
Mailing Address - Country:US
Mailing Address - Phone:865-356-2204
Mailing Address - Fax:
Practice Address - Street 1:515 ROCK BRIDGE RD
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-3318
Practice Address - Country:US
Practice Address - Phone:865-730-5016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPRN0000025364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily