Provider Demographics
NPI:1699364331
Name:BRYAN, CANDICE JONES (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:JONES
Last Name:BRYAN
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 1:12848 NC 131 HWY
Mailing Address - Street 2:
Mailing Address - City:BLADENBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28320-9088
Mailing Address - Country:US
Mailing Address - Phone:910-874-2513
Mailing Address - Fax:
Practice Address - Street 1:12848 NC 131 HWY
Practice Address - Street 2:
Practice Address - City:BLADENBORO
Practice Address - State:NC
Practice Address - Zip Code:28320-9088
Practice Address - Country:US
Practice Address - Phone:910-874-2513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF12200628363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily