Provider Demographics
NPI:1588075816
Name:TARVER, CANDRA
Entity type:Individual
Prefix:
First Name:CANDRA
Middle Name:
Last Name:TARVER
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 1:7595 BAYMEADOWS CIR W APT 1316
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1857
Mailing Address - Country:US
Mailing Address - Phone:904-562-9592
Mailing Address - Fax:
Practice Address - Street 1:7595 BAYMEADOWS CIR W APT 1316
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1857
Practice Address - Country:US
Practice Address - Phone:904-562-9592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA12171224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant