Provider Demographics
NPI:1316397458
Name:GOTT, CANDY L
Entity Type:Individual
Prefix:
First Name:CANDY
Middle Name:L
Last Name:GOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 ALOMA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3330
Mailing Address - Country:US
Mailing Address - Phone:407-679-9222
Mailing Address - Fax:407-679-9061
Practice Address - Street 1:2304 ALOMA AVE STE 100
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3330
Practice Address - Country:US
Practice Address - Phone:407-679-9222
Practice Address - Fax:407-679-9061
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9303972363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner