Provider Demographics
NPI:1750629572
Name:GAITANIS, CANDICE M (CFNP, ARNP)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:M
Last Name:GAITANIS
Suffix:
Gender:F
Credentials:CFNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1294 E VERDE BLVD
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-5376
Mailing Address - Country:US
Mailing Address - Phone:480-540-0767
Mailing Address - Fax:
Practice Address - Street 1:4864 E BASELINE RD STE 105
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4629
Practice Address - Country:US
Practice Address - Phone:480-558-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4770363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner