| Doctor Name: | CANDICE BLACK |
| NPI Number: | 1902201635 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | AGACNP |
| License Number: | AP126737 |
| Business Practice Address: | 200 W Ollie St Llano, TX - 786432628 |
| Business Phone Number: | 3252475040 |
| Business Fax Number: | |
| Mailing Address: | 123 Winding Way, SUNRISE BEACH |
| State: | TX |
| Postal Code: | 786439104 |
| Phone Number: | 8306130474 |
| Fax Number: | |
| NPI Enumeration Date: | 10/23/2014 |
| NPI Last Update Date: | 10/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | AP126737 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |