Provider Demographics
NPI:1700510690
Name:FISHER, CANDICE JONICE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:JONICE
Last Name:FISHER
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 1:14000 JERICHO PARK RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-9465
Mailing Address - Country:US
Mailing Address - Phone:443-734-8891
Mailing Address - Fax:
Practice Address - Street 1:3 GREENWOOD PL
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2762
Practice Address - Country:US
Practice Address - Phone:410-205-7698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-15
Last Update Date:2022-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily