Provider Demographics
NPI:1366676132
Name:BREAUX, CANDACE (AGACNP)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:
Last Name:BREAUX
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:MS
Other - First Name:CANDACE
Other - Middle Name:
Other - Last Name:GULUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1340 S DAMEN AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-1169
Mailing Address - Country:US
Mailing Address - Phone:312-262-2739
Mailing Address - Fax:312-564-4059
Practice Address - Street 1:1315 ST JOSEPH PKWY STE 1400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8237
Practice Address - Country:US
Practice Address - Phone:409-833-9797
Practice Address - Fax:409-839-3174
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137640363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology