Provider Demographics
NPI:1780292631
Name:BROWN, CANDACE MARIE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:MARIE
Last Name:BROWN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14207 MINDELLO DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-5678
Mailing Address - Country:US
Mailing Address - Phone:904-508-3990
Mailing Address - Fax:
Practice Address - Street 1:3049 CLEVELAND AVE STE 210
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7045
Practice Address - Country:US
Practice Address - Phone:904-508-3990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9362047163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty