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: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8263 PARAMOUNT PT
WINNABOW NC
28479-5843
US

IV. Provider business mailing address

8263 PARAMOUNT PT
WINNABOW NC
28479-5843
US

V. Phone/Fax

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

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
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026562
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number212783
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: