Basic Information
| Provider Information | |||||||||
| NPI: | 1164918470 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARIN | ||||||||
| FirstName: | CANDACE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 827 S HORNER BLVD | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273305342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197757926 | ||||||||
| FaxNumber: | 9197180092 | ||||||||
| Practice Location | |||||||||
| Address1: | 827 S HORNER BLVD | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 273305342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197757926 | ||||||||
| FaxNumber: | 9197180092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2018 | ||||||||
| LastUpdateDate: | 05/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9304162 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 9304162 | 01 | FL | ADVANCED REGISTERED NURSE PRACTITIONER | OTHER |