Provider Demographics
NPI:1508268772
Name:COCHRAN, CANDACE (FNP-C)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:COCHRAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 FULTON DR NW
Mailing Address - Street 2:STE 101
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2852
Mailing Address - Country:US
Mailing Address - Phone:330-433-9260
Mailing Address - Fax:
Practice Address - Street 1:4124 FULTON DR NW
Practice Address - Street 2:STE 101
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2852
Practice Address - Country:US
Practice Address - Phone:330-433-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 16582NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily