Provider Demographics
NPI:1700853728
Name:ELLIOTT, CANDACE A (C-FNP, C-ACNP, C-PMN)
Entity type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:A
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:C-FNP, C-ACNP, C-PMN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518B CREEKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-1457
Mailing Address - Country:US
Mailing Address - Phone:626-405-7197
Mailing Address - Fax:626-405-7164
Practice Address - Street 1:393 EAST WALNUT STREET
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91188
Practice Address - Country:US
Practice Address - Phone:626-405-7197
Practice Address - Fax:626-405-7164
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA248884363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP05787Medicare UPIN