Provider Demographics
NPI:1659627388
Name:WILLIS, CANDACE S (FNP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:S
Last Name:WILLIS
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 1:5001 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ERIN
Mailing Address - State:TN
Mailing Address - Zip Code:37061-4115
Mailing Address - Country:US
Mailing Address - Phone:931-289-4211
Mailing Address - Fax:731-249-9003
Practice Address - Street 1:5001 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ERIN
Practice Address - State:TN
Practice Address - Zip Code:37061-4115
Practice Address - Country:US
Practice Address - Phone:931-289-4211
Practice Address - Fax:731-249-9003
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN16883363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily