Provider Demographics
NPI:1104565936
Name:O'CONNELL, CANDICE CHRISTINA (APRN)
Entity type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:CHRISTINA
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:CANDICE
Other - Middle Name:CHRISTINA
Other - Last Name:BUCKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5380 TECH DATA DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-3122
Mailing Address - Country:US
Mailing Address - Phone:727-437-3012
Mailing Address - Fax:
Practice Address - Street 1:1929 ADLER NEST LN
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-2303
Practice Address - Country:US
Practice Address - Phone:904-626-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11019964363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care