Provider Demographics
NPI:1700166196
Name:STURGEON, CANDACE (NP)
Entity Type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:STURGEON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 W EL CAMINO REAL FL 3
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:415-923-6500
Mailing Address - Fax:415-558-5359
Practice Address - Street 1:2100 WEBSTER ST STE 110
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2374
Practice Address - Country:US
Practice Address - Phone:415-923-6500
Practice Address - Fax:415-558-5359
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95004161363L00000X, 363LA2100X
NYF430601363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95004161OtherSTATE MEDICAL LICENSE
CAML2452441OtherFEDERAL DEA LICENSE