Healthcare Provider Details

I. General information

NPI: 1013320373
Provider Name (Legal Business Name): CANDICE BRIANNE FROST APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDICE BURNSIDE

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 INDEPENDENCE BLVD STE 100
WILMINGTON NC
28412-0019
US

IV. Provider business mailing address

2512 INDEPENDENCE BLVD STE 100
WILMINGTON NC
28412-0019
US

V. Phone/Fax

Practice location:
  • Phone: 910-632-0133
  • Fax: 910-919-5547
Mailing address:
  • Phone: 910-632-0133
  • Fax: 910-919-5547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5021423
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004095
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: