Provider Demographics
NPI:1538685847
Name:BRANCH-JACOBS, CANDICE
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:
Last Name:BRANCH-JACOBS
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:PO BOX 14632
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27620-4632
Mailing Address - Country:US
Mailing Address - Phone:919-706-9845
Mailing Address - Fax:
Practice Address - Street 1:836 CROWN CROSSING LN
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-4063
Practice Address - Country:US
Practice Address - Phone:919-706-9845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor