Healthcare Provider Details

I. General information

NPI: 1457779316
Provider Name (Legal Business Name): CANDACE SMITH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 01/17/2022
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2513 OTTER TOTEM CT
SAINT AUGUSTINE FL
32092-2445
US

IV. Provider business mailing address

2513 OTTER TOTEM CT
ST AUGUSTINE FL
32092-2445
US

V. Phone/Fax

Practice location:
  • Phone: 904-687-8289
  • Fax:
Mailing address:
  • Phone: 904-687-8289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9260335
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: