Provider Demographics
NPI:1669798641
Name:MARTENS NICOLL, CANDICE D (ARNP)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:D
Last Name:MARTENS NICOLL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3434 HANCOCK BRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:N FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-7094
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2625
Practice Address - Street 1:2975 BOBCAT VILLAGE CENTER RD
Practice Address - Street 2:STE. 100
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34288-4600
Practice Address - Country:US
Practice Address - Phone:941-423-9936
Practice Address - Fax:941-426-9794
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3382212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFI974ZMedicare PIN