Healthcare Provider Details

I. General information

NPI: 1841805462
Provider Name (Legal Business Name): MRS. AMY ELIZABETH MCCANDLESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 STERTHAUS DR
ORMOND BEACH FL
32174-5130
US

IV. Provider business mailing address

12201 RESEARCH PKWY STE 300
ORLANDO FL
32826-3265
US

V. Phone/Fax

Practice location:
  • Phone: 386-301-4067
  • Fax:
Mailing address:
  • Phone: 407-823-2744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAPRN11016357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: