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NPI Code Detail

MEDICARE: MS. CANDACE BREAUX AGACNP

MEDICARE: MS. CANDACE BREAUX AGACNP
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
1363LG0600XGerontology Nurse PractitionerAP137640TX

General Provider Information

NPI Number : 1366676132
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CANDACE BREAUX AGACNP
Provider Business Mailing Address
First Line : 1340 S DAMEN AVE STE 400
Second Line :
City : CHICAGO
State : IL
Zip : 60608-1169
Country : US
Telephone Number : 312-262-2739
Fax Number : 312-564-4059
Provider Business Practice Location Address
First Line : 1315 ST JOSEPH PKWY STE 1400
Second Line :
City : HOUSTON
State : TX
Zip : 77002-8237
Country : US
Telephone Number : 409-833-9797
Fax Number : 409-839-3174
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2009
Last Update Date : 10/12/2020

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