=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285512046
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CANDELARIA MEDICAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2025
-----------------------------------------------------
Last Update Date | 08/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1417 N SEMORAN BLVD STE 106
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32807-3555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-704-7633
-----------------------------------------------------
Fax | 407-705-2152
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1417 N SEMORAN BLVD STE 106
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32807-3555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-704-7633
-----------------------------------------------------
Fax | 407-705-2152
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/DIRECTOR
-----------------------------------------------------
Name | LYNETTE CANDELARIA MERCED
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 787-363-7928
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 364SP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------