Provider Demographics
NPI:1942494919
Name:BREZOVEC, CANDACE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:
Last Name:BREZOVEC
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 W ELLIS ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3858
Mailing Address - Country:US
Mailing Address - Phone:602-717-1670
Mailing Address - Fax:480-219-6829
Practice Address - Street 1:1900 S HIGLEY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-4792
Practice Address - Country:US
Practice Address - Phone:480-219-6520
Practice Address - Fax:480-219-6829
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ113512367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered