Healthcare Provider Details

I. General information

NPI: 1558883850
Provider Name (Legal Business Name): CANDACE THOMSON MSN, APN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2017
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CAPITAL WAY
PENNINGTON NJ
08534-2520
US

IV. Provider business mailing address

1 CAPITAL WAY
PENNINGTON NJ
08534-2520
US

V. Phone/Fax

Practice location:
  • Phone: 609-303-4000
  • Fax:
Mailing address:
  • Phone: 609-303-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number719908-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN689304
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR19016300
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number26NJ00817500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: