Provider Demographics
NPI:1093114811
Name:ANTOINE-MORTON, CANDACE (FNP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:ANTOINE-MORTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:ANTOINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1079 E 73RD ST BSMT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5364
Mailing Address - Country:US
Mailing Address - Phone:212-464-7986
Mailing Address - Fax:
Practice Address - Street 1:9900 BREN RD E
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55343-9664
Practice Address - Country:US
Practice Address - Phone:929-441-2405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY339040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily