Provider Demographics
NPI:1699599712
Name:CANDELARIA, NITSA
Entity type:Individual
Prefix:
First Name:NITSA
Middle Name:
Last Name:CANDELARIA
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 1:319-43 STREET
Mailing Address - Street 2:APT. 2C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232
Mailing Address - Country:US
Mailing Address - Phone:917-676-7425
Mailing Address - Fax:
Practice Address - Street 1:319-43 STREET
Practice Address - Street 2:APT. 2C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11232
Practice Address - Country:US
Practice Address - Phone:917-676-7425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY708461-01163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health