Provider Demographics
NPI:1124466107
Name:LOGGINS, CANDIUS G (APN)
Entity type:Individual
Prefix:
First Name:CANDIUS
Middle Name:G
Last Name:LOGGINS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 CROSSINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3130
Mailing Address - Country:US
Mailing Address - Phone:615-941-8501
Mailing Address - Fax:
Practice Address - Street 1:5801 CROSSINGS BLVD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3130
Practice Address - Country:US
Practice Address - Phone:615-851-9401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1035I05868Medicare PIN