Provider Demographics
NPI:1467683854
Name:JENNINGS, CANDACE C (CRNA)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:C
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:CRNA
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 95000-2130
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2130
Mailing Address - Country:US
Mailing Address - Phone:201-804-2800
Mailing Address - Fax:201-804-8883
Practice Address - Street 1:175 MADISON AVE FL 1
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2099
Practice Address - Country:US
Practice Address - Phone:609-914-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12517400163W00000X
NJ26NJ00300900367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26NR12517400OtherREGISTERED NURSE STATE LICENSE