MEDICARE: MRS. JENNIFER CANDIFF FNP

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	95003651	CA

General Provider Information

NPI Number	:	1811355381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER CANDIFF FNP

Provider Business Mailing Address
First Line	:	12442 LIMONITE AVE
Second Line	:	SUITE 207
City	:	EASTVALE
State	:	CA
Zip	:	91752-2467
Country	:	US
Telephone Number	:	951-356-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	12442 LIMONITE AVE
Second Line	:	SUITE 207
City	:	EASTVALE
State	:	CA
Zip	:	91752-2467
Country	:	US
Telephone Number	:	951-356-8000
Fax Number	:

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

Provider Enumeration Date	:	01/29/2016
Last Update Date	:	12/02/2021

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