Healthcare Provider Details

I. General information

NPI: 1790830404
Provider Name (Legal Business Name): CANDICE ELIZABETH WHEALON R.N., FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDICE ELIZABETH ZIMMERMAN R.N.

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

11620 WILSHIRE BLVD STE 600
LOS ANGELES CA
90025-1776
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8888
  • Fax:
Mailing address:
  • Phone: 805-479-8503
  • Fax: 310-362-9240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number653544
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23718
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number23718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: