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General NPI Number Information
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NPI Number | 1578553962
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Entity Type | Individual
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Provider Name | CANDACE MCKNIGHT JOHNSON CRNP F MSN
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Gender | Female
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 5717 21ST AVE W
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City | BRADENTON
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State | FL
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Zip | 34209
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Country | US
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Telephone | 941-792-8383
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Fax | 941-792-8484
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Provider Business Mailing Address
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Address Line | 5717 21ST AVE W
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City | BRADENTON
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State | FL
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Zip | 34209
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Country | US
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Telephone | 941-792-8383
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Fax | 941-792-8484
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | LG-0000453
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN9495576
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R097401
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License Number State | MD
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