Provider Demographics
NPI:1083157291
Name:ROBERTSON, CANDICE (MSN, APN, NP-C)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MSN, APN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 ANGELA DR SUITE 202
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-1966
Mailing Address - Country:US
Mailing Address - Phone:732-908-4522
Mailing Address - Fax:
Practice Address - Street 1:21 ANGELA DR SUITE 202
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1966
Practice Address - Country:US
Practice Address - Phone:732-908-4522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-21
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00682100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily