1295240174 NPI number — MRS. CANDICE GABRIELLE BRASE FNP-C , RN

Table of content: MRS. CANDICE GABRIELLE BRASE FNP-C , RN (NPI 1295240174)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295240174 NPI number — MRS. CANDICE GABRIELLE BRASE FNP-C , RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRASE
Provider First Name:
CANDICE
Provider Middle Name:
GABRIELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C , RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ENGELMANN
Provider Other First Name:
CANDICE
Provider Other Middle Name:
GABRIELLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295240174
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2615 OAKWOOD GLEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CEDAR PARK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78613-5126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-299-5400
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2111 KRAMER LN STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78758-4032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-508-8320
Provider Business Practice Location Address Fax Number:
512-488-1745
Provider Enumeration Date:
12/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP135489 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com