Healthcare Provider Details

I. General information

NPI: 1497268635
Provider Name (Legal Business Name): CANDICE PRISCILLA GREGG ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDICE PRISCILLA GREGG RN

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 CENTERVILLE RD STE 202
TALLAHASSEE FL
32308-4638
US

IV. Provider business mailing address

1401 CENTERVILLE RD STE 202
TALLAHASSEE FL
32308-4638
US

V. Phone/Fax

Practice location:
  • Phone: 850-877-7241
  • Fax: 850-877-1338
Mailing address:
  • Phone: 850-877-7241
  • Fax: 850-877-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPRN9324581
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN9324581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: