Provider Demographics
NPI:1306516893
Name:BLACKWOOD, CANDICE NICOLE (FNP)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:NICOLE
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:NICOLE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:61 COUNTY ROAD 390
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:AL
Mailing Address - Zip Code:35673-3162
Mailing Address - Country:US
Mailing Address - Phone:256-345-8232
Mailing Address - Fax:
Practice Address - Street 1:2424 DANVILLE RD SW STE K
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4219
Practice Address - Country:US
Practice Address - Phone:256-309-5850
Practice Address - Fax:256-309-5851
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-156478363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily