Healthcare Provider Details

I. General information

NPI: 1427475102
Provider Name (Legal Business Name): CANDACE GOSNELL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDACE F GULLUNG CRNA

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 W MAIN ST
DOTHAN AL
36305-1056
US

IV. Provider business mailing address

PO BOX 680060
FRANKLIN TN
37068-0060
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-5000
  • Fax:
Mailing address:
  • Phone: 877-848-1457
  • Fax: 659-235-6176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number18896
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3-000259
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-123167
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number199699
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number24895
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: