Healthcare Provider Details

I. General information

NPI: 1922692227
Provider Name (Legal Business Name): CANDICE JOLENE DYKES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDICE JOLENE BROWN

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

851 TRAFALGAR CT STE 2003
MAITLAND FL
32751-4132
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN11013210
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: