1386466365 NPI number — CANDACE ESTHER FLORES APRN-CNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386466365 NPI number — CANDACE ESTHER FLORES APRN-CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLORES
Provider First Name:
CANDACE
Provider Middle Name:
ESTHER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN-CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OTT
Provider Other First Name:
CANDACE
Provider Other Middle Name:
ESTHER
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1386466365
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 844088
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-4088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-609-2258
Provider Business Mailing Address Fax Number:
505-609-2259

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4251 ENGLISH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMINGTON
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87402-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-609-6610
Provider Business Practice Location Address Fax Number:
505-599-4670
Provider Enumeration Date:
10/30/2024

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:  81531 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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