Healthcare Provider Details

I. General information

NPI: 1689754558
Provider Name (Legal Business Name): TRACEY CANDELORA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N FLAMINGO RD STE 11
PEMBROKE PINES FL
33028-1046
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-844-9790
  • Fax: 954-443-4751
Mailing address:
  • Phone: 954-276-5685
  • Fax: 954-984-7074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN1610012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: