Provider Demographics
NPI:1437812013
Name:DUCKING, CANDACE RAJONDA
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:RAJONDA
Last Name:DUCKING
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 1:302 LAKEVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1124
Mailing Address - Country:US
Mailing Address - Phone:863-280-4230
Mailing Address - Fax:
Practice Address - Street 1:302 LAKEVIEW BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-1124
Practice Address - Country:US
Practice Address - Phone:863-280-4230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251C00000X
372600000X, 385H00000X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No372600000XNursing Service Related ProvidersAdult Companion
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109520700Medicaid