Provider Demographics
NPI:1508628678
Name:COURTNEY, CANDACE (APRN)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11676 LITTLE RIVER WAY
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-3233
Mailing Address - Country:US
Mailing Address - Phone:732-887-6937
Mailing Address - Fax:
Practice Address - Street 1:11676 LITTLE RIVER WAY
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-3233
Practice Address - Country:US
Practice Address - Phone:732-887-6937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-25
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61526857363L00000X
FL11011782363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner