Provider Demographics
NPI:1811355381
Name:CANDIFF, JENNIFER (FNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:CANDIFF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:PITUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12442 LIMONITE AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:91752-2467
Mailing Address - Country:US
Mailing Address - Phone:951-356-8000
Mailing Address - Fax:
Practice Address - Street 1:12442 LIMONITE AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:91752-2467
Practice Address - Country:US
Practice Address - Phone:951-356-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily