Provider Demographics
NPI:1417430190
Name:DALTON, KANDACE M (APN)
Entity type:Individual
Prefix:
First Name:KANDACE
Middle Name:M
Last Name:DALTON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 22ND AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1852
Mailing Address - Country:US
Mailing Address - Phone:629-255-3486
Mailing Address - Fax:
Practice Address - Street 1:8384 BAYMEADOWS RD STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7486
Practice Address - Country:US
Practice Address - Phone:904-776-5846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704410354163WP0808X, 363LF0000X
TN187452163WP0808X
VA0024190006363LF0000X, 163WP0808X
FLAPRN11012993363LF0000X, 163WP0808X
TN24713363LF0000X
WAAP61593686163WP0808X, 363LF0000X
NY987178163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN24713OtherAPN LICENSE