MEDICARE: CANDICE LUCIANA VINCENT

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	163W00000X	Registered Nurse	9467707	FL

General Provider Information

NPI Number	:	1629646476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE LUCIANA VINCENT

Provider Business Mailing Address
First Line	:	4330 NW 173RD DR
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-3706
Country	:	US
Telephone Number	:	305-790-8843
Fax Number	:

Provider Business Practice Location Address
First Line	:	4330 NW 173RD DR
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-3706
Country	:	US
Telephone Number	:	305-790-8843
Fax Number	:

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

Provider Enumeration Date	:	06/16/2021
Last Update Date	:	06/16/2021

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Directions to “ CANDICE LUCIANA VINCENT ” Practice Location

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