Provider Demographics
NPI:1255116430
Name:JOHNSON, CANDACE CHAQUELLE' (MBA, DNP, APRN,FNP-C)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:CHAQUELLE'
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MBA, 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 1:1675 GARDEN OF GODS RD STE 2044
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-9444
Mailing Address - Country:US
Mailing Address - Phone:719-578-3199
Mailing Address - Fax:719-578-3114
Practice Address - Street 1:1675 GARDEN OF GODS RD STE 2044
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-9444
Practice Address - Country:US
Practice Address - Phone:719-578-3199
Practice Address - Fax:719-578-3114
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0999045363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily