Healthcare Provider Details

I. General information

NPI: 1306751722
Provider Name (Legal Business Name): CANDACE LUCILLE HODGE RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDACE GOLDEN

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7775 BAYMEADOWS WAY STE 200
JACKSONVILLE FL
32256-7531
US

IV. Provider business mailing address

6550 MISSION CT UNIT 5
JACKSONVILLE FL
32217-8823
US

V. Phone/Fax

Practice location:
  • Phone: 904-396-2199
  • Fax:
Mailing address:
  • Phone: 229-376-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: