Healthcare Provider Details

I. General information

NPI: 1760903538
Provider Name (Legal Business Name): CANDACE RAQUEL WULFF DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34041 US HIGHWAY 19 N STE D
PALM HARBOR FL
34684-2648
US

IV. Provider business mailing address

34041 US HIGHWAY 19 N STE D
PALM HARBOR FL
34684-2648
US

V. Phone/Fax

Practice location:
  • Phone: 727-493-0078
  • Fax:
Mailing address:
  • Phone: 727-493-0078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberLL51258
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberOS23993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: