Provider Demographics
NPI:1720748270
Name:CANDOW, REILLY ALICIA (PA-C)
Entity Type:Individual
Prefix:
First Name:REILLY
Middle Name:ALICIA
Last Name:CANDOW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REILLY
Other - Middle Name:ALICIA
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 E INTENDENCIA ST STE A-28
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-5806
Mailing Address - Country:US
Mailing Address - Phone:850-908-6810
Mailing Address - Fax:850-908-6819
Practice Address - Street 1:190 E INTENDENCIA ST STE A-28
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5806
Practice Address - Country:US
Practice Address - Phone:850-908-6810
Practice Address - Fax:850-908-6819
Is Sole Proprietor?:No
Enumeration Date:2021-12-25
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant