Provider Demographics
NPI:1962166983
Name:NOLLETTI, CANDIS BROOK (APRN, FNP)
Entity type:Individual
Prefix:MRS
First Name:CANDIS
Middle Name:BROOK
Last Name:NOLLETTI
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1639 TOWNSHIP ROAD 65
Mailing Address - Street 2:
Mailing Address - City:JEROMESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44840-9647
Mailing Address - Country:US
Mailing Address - Phone:330-749-7021
Mailing Address - Fax:
Practice Address - Street 1:1522 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3533
Practice Address - Country:US
Practice Address - Phone:419-207-1085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0028766363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily