Provider Demographics
NPI:1467491142
Name:DENNIS, CANDICE DONNA
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:DONNA
Last Name:DENNIS
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 1:1701 SW 16TH AVE
Mailing Address - Street 2:BUILDING B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1153
Mailing Address - Country:US
Mailing Address - Phone:352-334-0850
Mailing Address - Fax:352-334-0856
Practice Address - Street 1:1701 SW 16TH AVE
Practice Address - Street 2:BUILDING B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1153
Practice Address - Country:US
Practice Address - Phone:352-334-0850
Practice Address - Fax:352-334-0856
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2829812163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management