Provider Demographics
NPI:1164918470
Name:MARIN, CANDACE (ARNP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:MARIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 S HORNER BLVD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5342
Mailing Address - Country:US
Mailing Address - Phone:919-775-7926
Mailing Address - Fax:919-718-0092
Practice Address - Street 1:827 S HORNER BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5342
Practice Address - Country:US
Practice Address - Phone:919-775-7926
Practice Address - Fax:919-718-0092
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9304162363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL9304162OtherADVANCED REGISTERED NURSE PRACTITIONER