MEDICARE: MS. CANDACE A. ELLIOTT C-FNP, C-ACNP, C-PMN

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	363LA2100X	Acute Care Nurse Practitioner	248884	CA
2	363LF0000X	Family Nurse Practitioner	248884	CA

General Provider Information

NPI Number	:	1700853728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CANDACE A. ELLIOTT C-FNP, C-ACNP, C-PMN

Provider Business Mailing Address
First Line	:	1518B CREEKSIDE CT
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-1457
Country	:	US
Telephone Number	:	626-405-7197
Fax Number	:	626-405-7164

Provider Business Practice Location Address
First Line	:	393 EAST WALNUT STREET
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91188
Country	:	US
Telephone Number	:	626-405-7197
Fax Number	:	626-405-7164

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

Provider Enumeration Date	:	03/08/2006
Last Update Date	:	03/27/2012

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