Provider Demographics
NPI:1699423426
Name:CANDALES ARAFET, LUIS ALBERTO (APRN)
Entity type:Individual
Prefix:
First Name:LUIS ALBERTO
Middle Name:
Last Name:CANDALES ARAFET
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:LUIS
Other - Middle Name:ALBERTO
Other - Last Name:CANDALES ARAFET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 25487
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34277-2487
Mailing Address - Country:US
Mailing Address - Phone:941-202-5342
Mailing Address - Fax:855-253-4836
Practice Address - Street 1:1111 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6713
Practice Address - Country:US
Practice Address - Phone:813-643-3242
Practice Address - Fax:813-643-3090
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018635363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner