Provider Demographics
NPI:1689754558
Name:CANDELORA, TRACEY (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TRACEY
Middle Name:
Last Name:CANDELORA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-984-7074
Practice Address - Street 1:801 N FLAMINGO RD STE 11
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1046
Practice Address - Country:US
Practice Address - Phone:954-844-9790
Practice Address - Fax:954-443-4751
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN1610012363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health