Provider Demographics
NPI:1720068042
Name:KOCHOUNIAN, CANDICE (ARNP)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:KOCHOUNIAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 LITTLE RD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655
Mailing Address - Country:US
Mailing Address - Phone:727-376-7820
Mailing Address - Fax:727-376-7799
Practice Address - Street 1:14100 FIVAY RD
Practice Address - Street 2:SUITE 310
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667
Practice Address - Country:US
Practice Address - Phone:727-862-3202
Practice Address - Fax:727-862-2182
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1348362363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q26513Medicare UPIN
FLU35504Medicare ID - Type Unspecified