Healthcare Provider Details

I. General information

NPI: 1376364851
Provider Name (Legal Business Name): CANDICE CORLEONE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2024
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 E PALMDALE BLVD # 533A-1
PALMDALE CA
93550-2374
US

IV. Provider business mailing address

PO BOX 160
LLANO CA
93544-0160
US

V. Phone/Fax

Practice location:
  • Phone: 800-576-5544
  • Fax:
Mailing address:
  • Phone: 562-852-2927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022642
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: