Provider Demographics
NPI:1225738990
Name:ANDERSON, CANDICE JUSEL (CNM)
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:JUSEL
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8110 ROYAL PALM BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5742
Mailing Address - Country:US
Mailing Address - Phone:954-341-8288
Mailing Address - Fax:
Practice Address - Street 1:8110 ROYAL PALM BLVD STE 108
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5742
Practice Address - Country:US
Practice Address - Phone:954-341-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024686367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife