MEDICARE: CANDACE K HALL FNP-C

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	363LF0000X	Family Nurse Practitioner	0024179004	VA
2	363L00000X	Nurse Practitioner	0024179004	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801412242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE K HALL FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 381468
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38183-1468
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7915 LAKE MANASSAS DR STE 302
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3260
Country	:	US
Telephone Number	:	571-248-0653
Fax Number	:	571-248-0658

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

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	02/13/2026

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