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General NPI Number Information
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NPI Number | 1669798641
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Entity Type | Individual
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Provider Name | CANDICE D MARTENS NICOLL ARNP
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Gender | Female
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 2975 BOBCAT VILLAGE CENTER RD STE. 100
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City | NORTH PORT
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State | FL
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Zip | 34288-4600
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Country | US
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Telephone | 941-423-9936
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Fax | 941-426-9794
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Provider Business Mailing Address
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Address Line | 3434 HANCOCK BRIDGE PKWY
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City | N FT MYERS
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State | FL
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Zip | 33903-7094
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Country | US
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Telephone | 877-856-3774
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Fax | 239-599-2625
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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 | ARNP3382212
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License Number State | FL
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