Healthcare Provider Details

I. General information

NPI: 1851621536
Provider Name (Legal Business Name): VICTOR IGNACIO CANDELARIO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: VICTOR KLINGSHIRN ARNP

II. Dates (important events)

Enumeration Date: 01/03/2010
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5935 PROVIDENCE GLEN RD
CHARLOTTE NC
28270-3722
US

IV. Provider business mailing address

5935 PROVIDENCE GLEN RD
CHARLOTTE NC
28270-3722
US

V. Phone/Fax

Practice location:
  • Phone: 980-457-5645
  • Fax:
Mailing address:
  • Phone: 980-457-5645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9221773
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5010300
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95005933
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: