NPIMap

Individual provider Active NPI

Kandice L Tolic, RN, MSN, WHCNP

  • Nurse Practitioner
  • Saint Paul, MN
National Provider Identifier
1598840159
Registry record updated Apr 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
2652 Issued in MN
Practice address
640 Jackson St
Saint Paul, MN 55101-2502
Phone
(651) 254-3448
Fax
(651) 254-3470
NPI assigned
Oct 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X R139022-7 MN
Nurse Practitioner 363L00000X 2652 MN Primary

Addresses

Primary practice location

640 Jackson St
Saint Paul, MN 55101-2502

Mailing address

8170 33Rd Ave S
Ms 21110Q
Minneapolis, MN 55425-4516

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070228000510 MN Practitioner - Nurse Practitioner 8224130810 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Minnesota Medical School, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Park Nicollet ClinicGroup PAC ID 7911819438, 1,778 clinicians
Group Health IncGroup PAC ID 1759293954, 1,627 clinicians

Practice addresses (Care Compare)

5320 Hyland Greens Dr
Bloomington, MN 55437-3934
Phone (952) 993-2400

640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 221-3456

6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-3123

8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148

Hospital & facility affiliations

  • Regions Hospital Hospital, Saint Paul, MN, CCN 240106
  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
2652MNMDRegistered Dietitian
R139022-7MNMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Park Nicollet Clinic CurrentSince Apr 23, 2015 Accepting new patients
Park Nicollet Clinic CurrentSince Apr 23, 2015 Accepting new patients
Group Health, Inc. Current Accepting new patients
Group Health, Inc. CurrentSince Jan 29, 2007 Accepting new patients

Locations

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

5320 Hyland Greens Dr
Minneapolis, MN 55437
Phone (952) 993-2400

2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600

8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

205 Wabasha St S
Stop 31300A
Saint Paul, MN 55107
Phone (651) 293-8100

3931 Louisiana Ave S
St Louis Park, MN 55426
Phone (952) 993-3230

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618790400000",
    "number": "1598840159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S",
            "address_2": "MS 21110Q",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 JACKSON ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551012502",
            "telephone_number": "651-254-3448",
            "fax_number": "651-254-3470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOLIC",
        "first_name": "KANDICE",
        "middle_name": "L",
        "credential": "RN, MSN, WHCNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-25",
        "last_updated": "2021-04-19",
        "certification_date": "2021-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "MN",
            "license": "R139022-7",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "2652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.