Provider Demographics
NPI:1366059347
Name:TICKLE, CANDACE
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:TICKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12201 RESEARCH PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-3265
Mailing Address - Country:US
Mailing Address - Phone:407-823-2744
Mailing Address - Fax:
Practice Address - Street 1:12201 RESEARCH PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-3265
Practice Address - Country:US
Practice Address - Phone:407-823-2744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPR11020311363LF0000X
390200000X
COC-APN.0004329-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program