Provider Demographics
NPI:1245579440
Name:CALDERON, CANDI (CPNP)
Entity Type:Individual
Prefix:MRS
First Name:CANDI
Middle Name:
Last Name:CALDERON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:PORT ST JOE
Mailing Address - State:FL
Mailing Address - Zip Code:32456-1303
Mailing Address - Country:US
Mailing Address - Phone:850-227-9220
Mailing Address - Fax:850-227-9219
Practice Address - Street 1:202 W HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PORT ST JOE
Practice Address - State:FL
Practice Address - Zip Code:32456-1303
Practice Address - Country:US
Practice Address - Phone:850-227-9220
Practice Address - Fax:850-227-9219
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN217780363LP0200X
FLAPRN11009155363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics