MEDICARE: CANDICE DANBURY FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	28007	SC

General Provider Information

NPI Number	:	1629850987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE DANBURY FNP-BC

Provider Business Mailing Address
First Line	:	3800 S OCEAN DR STE 209
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33019-2915
Country	:	US
Telephone Number	:	800-226-8874
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 HEATHER GREEN DR
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-7831
Country	:	US
Telephone Number	:	803-382-2300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2023
Last Update Date	:	02/20/2024

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