Provider Demographics
NPI:1598011611
Name:LUMIA, CANDACE I (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CANDACE
Middle Name:I
Last Name:LUMIA
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 1:323 CROMWELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067
Mailing Address - Country:US
Mailing Address - Phone:860-384-9666
Mailing Address - Fax:
Practice Address - Street 1:323 CROMWELL AVE
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1801
Practice Address - Country:US
Practice Address - Phone:860-384-9666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4793363LF0000X
CT004793363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004041000Medicaid
CT008022626Medicaid
CT500000315Medicaid
CT008039745Medicaid
CT008042339Medicaid
CT008003745Medicaid
CT004082260Medicaid
CT004082286Medicaid
CT008001325Medicaid
CTC01033OtherAPT FOUNDATION PTAN
CTD400081205OtherGROUP MEMBER MEDICARE
CT004217099Medicaid
CT008022622Medicaid
CT008023170Medicaid
CT008024427Medicaid