Provider Demographics
NPI:1326490632
Name:HADDOCK, CANDACE AYLA (AA)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:AYLA
Last Name:HADDOCK
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:LESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 840862
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0862
Mailing Address - Country:US
Mailing Address - Phone:303-377-7638
Mailing Address - Fax:303-780-0787
Practice Address - Street 1:8000 E MAPLEWOOD AVE STE 200
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4727
Practice Address - Country:US
Practice Address - Phone:303-438-3999
Practice Address - Fax:720-439-9500
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COANT.0000112367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant