Provider Demographics
NPI:1699446484
Name:CANDELARIA, LYNETTE (APRN)
Entity type:Individual
Prefix:
First Name:LYNETTE
Middle Name:
Last Name:CANDELARIA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 BUDINGER AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4123
Mailing Address - Country:US
Mailing Address - Phone:352-536-8644
Mailing Address - Fax:407-498-3402
Practice Address - Street 1:1330 BUDINGER AVE STE 108
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4123
Practice Address - Country:US
Practice Address - Phone:352-536-8644
Practice Address - Fax:407-498-3402
Is Sole Proprietor?:No
Enumeration Date:2021-09-22
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11015529363LF0000X, 363LA2200X
FL11015529363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112702100Medicaid