Healthcare Provider Details

I. General information

NPI: 1255512000
Provider Name (Legal Business Name): CANDICE MARIA VAKNIN MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2007
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 CHENEY HWY UNIT 4
TITUSVILLE FL
32780-6356
US

IV. Provider business mailing address

1057 CHENEY HWY
TITUSVILLE FL
32780-6356
US

V. Phone/Fax

Practice location:
  • Phone: 321-385-7210
  • Fax: 321-425-8536
Mailing address:
  • Phone: 321-385-7210
  • Fax: 321-425-8536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9329589
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5164388
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9329589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: