Provider Demographics
NPI:1174931059
Name:CANIDATE, ANESSA
Entity type:Individual
Prefix:
First Name:ANESSA
Middle Name:
Last Name:CANIDATE
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 1:925 ARLINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:FL
Mailing Address - Zip Code:32351-4029
Mailing Address - Country:US
Mailing Address - Phone:850-321-6343
Mailing Address - Fax:850-627-2130
Practice Address - Street 1:925 ARLINGTON CIR
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:FL
Practice Address - Zip Code:32351-4029
Practice Address - Country:US
Practice Address - Phone:850-321-6343
Practice Address - Fax:850-627-2130
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688704096Medicaid