Healthcare Provider Details

I. General information

NPI: 1033085204
Provider Name (Legal Business Name): CANDICE KILROY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 STIRLING CENTER PL
LAKE MARY FL
32746-5714
US

IV. Provider business mailing address

755 STIRLING CENTER PL
LAKE MARY FL
32746-5714
US

V. Phone/Fax

Practice location:
  • Phone: 407-333-1718
  • Fax:
Mailing address:
  • Phone: 401-333-1718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11042604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: