Healthcare Provider Details

I. General information

NPI: 1679482418
Provider Name (Legal Business Name): CANDACE AIDA BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5218 E TERRACE DR
MADISON WI
53718-8340
US

IV. Provider business mailing address

2530 CITRUS TOWER BLVD APT 18205
CLERMONT FL
34711-6931
US

V. Phone/Fax

Practice location:
  • Phone: 866-508-0748
  • Fax:
Mailing address:
  • Phone: 407-247-1085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: