Healthcare Provider Details

I. General information

NPI: 1700510690
Provider Name (Legal Business Name): CANDICE JONICE ANGLIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 OLNEY SANDY SPRING RD
OLNEY MD
20832-1408
US

IV. Provider business mailing address

3110 OLNEY SANDY SPRING RD
OLNEY MD
20832-1408
US

V. Phone/Fax

Practice location:
  • Phone: 301-774-6155
  • Fax: 301-774-2222
Mailing address:
  • Phone: 301-774-6155
  • Fax: 301-774-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4036312
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR196232
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: