Provider Demographics
NPI:1225334766
Name:BROMLEY, CANDACE LEIGH (PA-C)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:LEIGH
Last Name:BROMLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 ROCKY MOUNTAIN AVE STE 360
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9004
Mailing Address - Country:US
Mailing Address - Phone:970-221-1000
Mailing Address - Fax:970-624-1892
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE STE 360
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:970-221-1000
Practice Address - Fax:970-624-1892
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00449400363AM0700X
PAMA054798363AM0700X
COPA.0006588363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical