Provider Demographics
NPI:1306358684
Name:GIGLIOTTI, CANDRA SUE (NP)
Entity Type:Individual
Prefix:
First Name:CANDRA
Middle Name:SUE
Last Name:GIGLIOTTI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CANDRA
Other - Middle Name:SUE
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-0485
Mailing Address - Country:US
Mailing Address - Phone:765-599-3177
Mailing Address - Fax:765-599-3176
Practice Address - Street 1:1000 N 16TH ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4319
Practice Address - Country:US
Practice Address - Phone:765-599-3177
Practice Address - Fax:765-599-3176
Is Sole Proprietor?:No
Enumeration Date:2017-10-26
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPENDING363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner