Provider Demographics
NPI:1245029032
Name:ST JOHN, CANDICE
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:ST JOHN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19975
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33416-4975
Mailing Address - Country:US
Mailing Address - Phone:561-543-3946
Mailing Address - Fax:
Practice Address - Street 1:8401 LAKE WORTH RD STE 124
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2400
Practice Address - Country:US
Practice Address - Phone:561-543-3946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9367138163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse