Provider Demographics
NPI:1285512046
Name:CANDELARIA MEDICAL SERVICES LLC
Entity type:Organization
Organization Name:CANDELARIA MEDICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDELARIA MERCED
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:787-363-7928
Mailing Address - Street 1:1417 N SEMORAN BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3555
Mailing Address - Country:US
Mailing Address - Phone:407-704-7633
Mailing Address - Fax:407-705-2152
Practice Address - Street 1:1417 N SEMORAN BLVD STE 106
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3555
Practice Address - Country:US
Practice Address - Phone:407-704-7633
Practice Address - Fax:407-705-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty