Provider Demographics
NPI:1548408479
Name:NELMS, CANDICE DARA (AP, DIPL OM)
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:DARA
Last Name:NELMS
Suffix:
Gender:F
Credentials:AP, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 NW 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1560
Mailing Address - Country:US
Mailing Address - Phone:305-389-4905
Mailing Address - Fax:
Practice Address - Street 1:2817 NW 45TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1560
Practice Address - Country:US
Practice Address - Phone:305-389-4905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2636171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC000LOtherBLUE CROSS BLUE SHIELD