Provider Demographics
NPI:1912638586
Name:BROWN, CANDANCE WALENCIA (RN)
Entity type:Individual
Prefix:MS
First Name:CANDANCE
Middle Name:WALENCIA
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2223 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4796
Mailing Address - Country:US
Mailing Address - Phone:772-667-0107
Mailing Address - Fax:772-448-8825
Practice Address - Street 1:2223 S 25TH ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4796
Practice Address - Country:US
Practice Address - Phone:772-667-0107
Practice Address - Fax:772-448-8825
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL9360064163WC0400X, 163WW0000X, 163WC2100X, 163WD0400X, 163WI0500X, 163WX1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC2100XNursing Service ProvidersRegistered NurseContinence Care
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care