Healthcare Provider Details

I. General information

NPI: 1720068042
Provider Name (Legal Business Name): CANDICE KOCHOUNIAN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 FIVAY RD SUITE 310
HUDSON FL
34667
US

IV. Provider business mailing address

2055 LITTLE RD
TRINITY FL
34655
US

V. Phone/Fax

Practice location:
  • Phone: 727-862-3202
  • Fax: 727-862-2182
Mailing address:
  • Phone: 727-376-7820
  • Fax: 727-376-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP1348362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: