MEDICARE: CANDACE ALICIA GALLIMORE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	F07202088	FL

General Provider Information

NPI Number	:	1366243008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE ALICIA GALLIMORE FNP

Provider Business Mailing Address
First Line	:	2758 YOUNGFORD ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-4268
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2758 YOUNGFORD ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32824-4268
Country	:	US
Telephone Number	:	321-945-9996
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2025
Last Update Date	:	03/20/2025

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