Provider Demographics
NPI:1710511316
Name:OLIVAS, CANDACE (PNP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:OLIVAS
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 FRANKFORT AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-1114
Mailing Address - Country:US
Mailing Address - Phone:915-626-4257
Mailing Address - Fax:
Practice Address - Street 1:11351 JAMES WATT DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-6627
Practice Address - Country:US
Practice Address - Phone:915-225-3807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145217363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics