Provider Demographics
NPI:1144984758
Name:HUDDLESTON, CANDLER
Entity type:Individual
Prefix:
First Name:CANDLER
Middle Name:
Last Name:HUDDLESTON
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 1:1638 54TH AVE N APT 133
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-1887
Mailing Address - Country:US
Mailing Address - Phone:615-796-3560
Mailing Address - Fax:
Practice Address - Street 1:300 20TH AVE N STE G1
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2132
Practice Address - Country:US
Practice Address - Phone:615-941-8550
Practice Address - Fax:615-941-8507
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30560363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner