Provider Demographics
NPI:1376364851
Name:CORLEONE, CANDICE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:
Last Name:CORLEONE
Suffix:
Gender:F
Credentials:FNP-BC
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 160
Mailing Address - Street 2:
Mailing Address - City:LLANO
Mailing Address - State:CA
Mailing Address - Zip Code:93544-0160
Mailing Address - Country:US
Mailing Address - Phone:562-852-2927
Mailing Address - Fax:
Practice Address - Street 1:533 E PALMDALE BLVD # 533A-1
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-2374
Practice Address - Country:US
Practice Address - Phone:800-576-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily