Healthcare Provider Details

I. General information

NPI: 1063253664
Provider Name (Legal Business Name): CANDACE ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E 10TH ST
ANNISTON AL
36207-4716
US

IV. Provider business mailing address

1800 PARKER LN
OXFORD AL
36203-3250
US

V. Phone/Fax

Practice location:
  • Phone: 256-235-5121
  • Fax:
Mailing address:
  • Phone: 256-770-1580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-157944
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: