Provider Demographics
NPI:1922442094
Name:DEBERARDINIS, CANDACE ANNE (ARNP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:ANNE
Last Name:DEBERARDINIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CANDACE
Other - Middle Name:ANNE
Other - Last Name:MCKINNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1400 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2134
Mailing Address - Country:US
Mailing Address - Phone:407-648-3800
Mailing Address - Fax:321-841-3794
Practice Address - Street 1:1400 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2134
Practice Address - Country:US
Practice Address - Phone:321-648-3800
Practice Address - Fax:321-841-3794
Is Sole Proprietor?:No
Enumeration Date:2013-04-19
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9263513363LA2200X
FLARNP9263513363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health