Provider Demographics
NPI:1457664104
Name:REYNOLDS, CANDICE LATRICE (PMHNP-BC, FNP-C)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:LATRICE
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2139 N UNIVERSITY DR
Mailing Address - Street 2:PMB 3000
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6134
Mailing Address - Country:US
Mailing Address - Phone:302-399-3019
Mailing Address - Fax:
Practice Address - Street 1:1609 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-5148
Practice Address - Country:US
Practice Address - Phone:302-257-3135
Practice Address - Fax:302-526-2410
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC005517363LF0000X
FLAPRN9486111363LF0000X, 363LP0808X
MDAC005680363LP0808X
DEL8-0010481363LP0808X
DELG-0000531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health