Provider Demographics
NPI:1619570546
Name:JARRELL, CANDICE RHIANNON (FNP)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:RHIANNON
Last Name:JARRELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 CENTRAL AVE UNIT 168
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1615
Mailing Address - Country:US
Mailing Address - Phone:304-206-1636
Mailing Address - Fax:
Practice Address - Street 1:1560 CENTRAL AVE UNIT 168
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1615
Practice Address - Country:US
Practice Address - Phone:304-206-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-22
Last Update Date:2020-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009890363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner