Healthcare Provider Details

I. General information

NPI: 1316712953
Provider Name (Legal Business Name): CANDICE NICOLE NORSESIAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AEROSPACE BLVD # 500
DAYTONA BEACH FL
32114-3910
US

IV. Provider business mailing address

1 AEROSPACE BLVD # 500
DAYTONA BEACH FL
32114-3910
US

V. Phone/Fax

Practice location:
  • Phone: 386-226-7917
  • Fax:
Mailing address:
  • Phone: 386-226-7917
  • Fax: 386-226-6082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License NumberAPRN11029404
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11029404
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: