Healthcare Provider Details

I. General information

NPI: 1376939652
Provider Name (Legal Business Name): CANDICE L VANDERSCHAAF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 PROFESSIONAL CENTER DR
ORANGE PARK FL
32073-4461
US

IV. Provider business mailing address

PO BOX 45278
JACKSONVILLE FL
32232-5278
US

V. Phone/Fax

Practice location:
  • Phone: 904-276-4500
  • Fax: 904-276-4160
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-393-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9278804
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9278804
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: