Provider Demographics
NPI:1265518575
Name:CROFT, CANDACE NASON (RD)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:NASON
Last Name:CROFT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 ATLAS AVE
Mailing Address - Street 2:HEALTH AND WELLNESS CENTER
Mailing Address - City:PATRICK AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32925-3406
Mailing Address - Country:US
Mailing Address - Phone:321-494-2660
Mailing Address - Fax:
Practice Address - Street 1:1223 ATLAS AVE
Practice Address - Street 2:HEALTH AND WELLNESS CENTER
Practice Address - City:PATRICK AFB
Practice Address - State:FL
Practice Address - Zip Code:32925-3406
Practice Address - Country:US
Practice Address - Phone:321-494-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-29
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 3574133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered