Provider Demographics
NPI:1114929130
Name:CERRACCHIO, CANDICE SARA (PA C)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:SARA
Last Name:CERRACCHIO
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CANDLER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6093
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 CANDLER DR STE 100
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6093
Practice Address - Country:US
Practice Address - Phone:912-352-1700
Practice Address - Fax:912-354-8545
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6240363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA078731HPVMedicare PIN
PA449251Medicare PIN
Q15059Medicare UPIN