Provider Demographics
NPI:1346623493
Name:TATE, CANDICE (NP-C)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:FAYE
Other - Last Name:SPELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 FORSYTH ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-1408
Mailing Address - Country:US
Mailing Address - Phone:478-743-1000
Mailing Address - Fax:
Practice Address - Street 1:1600 FORSYTH ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-1408
Practice Address - Country:US
Practice Address - Phone:478-743-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN187247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily