Healthcare Provider Details

I. General information

NPI: 1942119789
Provider Name (Legal Business Name): CANDIS WILLIAMS AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CAPITAL CIR NE
TALLAHASSEE FL
32301-3558
US

IV. Provider business mailing address

PO BOX 324
CAMPBELLTON FL
32426-0324
US

V. Phone/Fax

Practice location:
  • Phone: 850-209-8788
  • Fax:
Mailing address:
  • Phone: 850-209-8788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11043909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: