Healthcare Provider Details

I. General information

NPI: 1295240174
Provider Name (Legal Business Name): CANDICE GABRIELLE BRASE FNP-C , RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS CANDICE GABRIELLE ENGELMANN

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 STROH PL
LONGMONT CO
80501-3214
US

IV. Provider business mailing address

PO BOX 641519
LOS ANGELES CA
90064-6519
US

V. Phone/Fax

Practice location:
  • Phone: 833-379-6863
  • Fax:
Mailing address:
  • Phone: 833-379-6863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.1000510-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: