Provider Demographics
NPI:1508690751
Name:OWENS, CANDICE (FNP-C)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:OWENS
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 1:5050 SUNRISE LN
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-2314
Mailing Address - Country:US
Mailing Address - Phone:404-803-7296
Mailing Address - Fax:
Practice Address - Street 1:2620 OLD WINDER HWY
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-6105
Practice Address - Country:US
Practice Address - Phone:678-821-2401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily