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NPI Code Detail

MEDICARE: CANDACE ROSE MUSGROVE NP

MEDICARE: CANDACE ROSE MUSGROVE NP
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
1363LF0000XFamily Nurse Practitioner217571GA

General Provider Information

NPI Number : 1982239141
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDACE ROSE MUSGROVE NP
Provider Business Mailing Address
First Line : 67 KINGSRIDGE DR
Second Line :
City : BROXTON
State : GA
Zip : 31519-6543
Country : US
Telephone Number : 912-592-5563
Fax Number :
Provider Business Practice Location Address
First Line : 1101 OCILLA RD
Second Line :
City : DOUGLAS
State : GA
Zip : 31533-2262
Country : US
Telephone Number : 912-384-1900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2020
Last Update Date : 03/10/2020

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