Provider Demographics
NPI:1821509936
Name:KUPHAL, CANDACE (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:KUPHAL
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 FLETCHER DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32611-2038
Mailing Address - Country:US
Mailing Address - Phone:352-875-5397
Mailing Address - Fax:
Practice Address - Street 1:280 FLETCHER DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611
Practice Address - Country:US
Practice Address - Phone:352-875-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-16
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN229872363LF0000X
MN5490363LF0000X
FLAPRN11000805363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104198900Medicaid