Provider Demographics
NPI:1326725243
Name:LOUCKS, CANDACE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:
Last Name:LOUCKS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7493 PATRIOTS LANDING PL
Mailing Address - Street 2:
Mailing Address - City:QUINTON
Mailing Address - State:VA
Mailing Address - Zip Code:23141-1641
Mailing Address - Country:US
Mailing Address - Phone:804-244-0459
Mailing Address - Fax:
Practice Address - Street 1:7493 PATRIOTS LANDING PL
Practice Address - Street 2:
Practice Address - City:QUINTON
Practice Address - State:VA
Practice Address - Zip Code:23141-1641
Practice Address - Country:US
Practice Address - Phone:804-244-0459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187193363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily