Healthcare Provider Details

I. General information

NPI: 1457664104
Provider Name (Legal Business Name): CANDICE LATRICE REYNOLDS PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 S STATE ST
DOVER DE
19901-4948
US

IV. Provider business mailing address

2139 N UNIVERSITY DR PMB 3000
CORAL SPRINGS FL
33071-6134
US

V. Phone/Fax

Practice location:
  • Phone: 302-257-3135
  • Fax: 302-526-2410
Mailing address:
  • Phone: 302-399-3019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC005517
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9486111
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9486111
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAC005680
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0010481
License Number StateDE
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG-0000531
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: