MEDICARE: VICTOR IGNACIO CANDELARIO APRN

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	ARNP9221773	FL
2	363LF0000X	Family Nurse Practitioner	5010300	NC
3	363LF0000X	Family Nurse Practitioner	95005933	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851621536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTOR IGNACIO CANDELARIO APRN

Provider Business Mailing Address
First Line	:	5935 PROVIDENCE GLEN RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-3722
Country	:	US
Telephone Number	:	980-457-5645
Fax Number	:

Provider Business Practice Location Address
First Line	:	5935 PROVIDENCE GLEN RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28270-3722
Country	:	US
Telephone Number	:	980-457-5645
Fax Number	:

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

Provider Enumeration Date	:	01/03/2010
Last Update Date	:	04/16/2026

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