Provider Demographics
NPI:1174076665
Name:TANKSLEY, CANDICE RENITA (RN)
Entity type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:RENITA
Last Name:TANKSLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:735 EDGECREEK TRL
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-1880
Mailing Address - Country:US
Mailing Address - Phone:585-743-7049
Mailing Address - Fax:
Practice Address - Street 1:735 EDGECREEK TRL
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-1880
Practice Address - Country:US
Practice Address - Phone:585-743-7049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22 668666163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse