Healthcare Provider Details

I. General information

NPI: 1649612656
Provider Name (Legal Business Name): CANDACE NICOLE HUDDLESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SE HILLMOOR DR STE 104
PORT ST LUCIE FL
34952-8057
US

IV. Provider business mailing address

2100 SE HILLMOOR DR STE 104
PORT ST LUCIE FL
34952-8057
US

V. Phone/Fax

Practice location:
  • Phone: 865-637-9711
  • Fax:
Mailing address:
  • Phone: 865-637-9711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: