Provider Demographics
NPI:1235791047
Name:DONALDSON, CANDACE VICTORIA (APRN)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:VICTORIA
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3489 HIGHWAY 162
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-5825
Mailing Address - Country:US
Mailing Address - Phone:850-373-8588
Mailing Address - Fax:
Practice Address - Street 1:3489 HIGHWAY 162
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-5825
Practice Address - Country:US
Practice Address - Phone:850-373-8588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002881363LF0000X
FLAPRN11002881363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily