Active NPI
Candus Nicole Antolin, MD
- Child & Adolescent Psychiatry Physician
- Tacoma, WA
National Provider Identifier
1316449820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- MD-21233
- Practice address
- 9923A E. Johnson St
Madigan Annex, JBLM
Tacoma, WA 98498 - Phone
- (253) 968-6485
- NPI assigned
- Mar 1, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | MD-21233 | HI | Primary |
Addresses
Primary practice location
9923A E. Johnson St
Madigan Annex, JBLM
Tacoma, WA 98498
Mailing address
9923A E. Johnson St
Madigan Annex, JBLM
Tacoma, WA 98498
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| VAD000 | Other | MEDICARE UPIN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD-21233 | HI | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743638400000",
"number": "1316449820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9923A E. JOHNSON ST",
"address_2": "MADIGAN ANNEX, JBLM",
"city": "TACOMA",
"state": "WA",
"postal_code": "98498"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9923A E. JOHNSON ST",
"address_2": "MADIGAN ANNEX, JBLM",
"city": "TACOMA",
"state": "WA",
"postal_code": "98498",
"telephone_number": "253-968-6485"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTOLIN",
"first_name": "CANDUS",
"middle_name": "NICOLE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-01",
"last_updated": "2025-04-03",
"certification_date": "2025-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "HI",
"license": "MD-21233",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE UPIN",
"identifier": "VAD000",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.