Provider Demographics
NPI:1902439458
Name:MARBACH, CANDICE (PA)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:MARBACH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6815
Mailing Address - Country:US
Mailing Address - Phone:908-500-5173
Mailing Address - Fax:
Practice Address - Street 1:985 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6815
Practice Address - Country:US
Practice Address - Phone:908-500-5173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-12
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program