Individual provider Active NPI

Tracey Candelora, ARNP

  • Adult Health Nurse Practitioner
  • Pembroke Pines, FL
National Provider Identifier
1689754558
Registry record updated Mar 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APRN1610012 Issued in FL
Practice address
801 N Flamingo Rd Ste 11
Pembroke Pines, FL 33028-1046
Phone
(954) 844-9790
Fax
(954) 443-4751
NPI assigned
Oct 16, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X APRN1610012 FL Primary

Addresses

Primary practice location

801 N Flamingo Rd Ste 11
Pembroke Pines, FL 33028-1046

Mailing address

2900 Corporate Way
Door D
Miramar, FL 33025-3925
Phone (954) 276-5685

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tcandelora107833@MHSDIRECT.NET Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150924000588 FL Practitioner - Nurse Practitioner 5799093787 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
South Broward Hospital DistrictGroup PAC ID 8123927373, 659 clinicians

Practice addresses (Care Compare)

801 N Flamingo Rd
Suite 11
Pembroke Pines, FL 33028-1019
Phone (954) 844-6868

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN1610012FLMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
South Broward Hospital District CurrentSince Jun 1, 2015 Accepting new patients
South Broward Hospital District CurrentSince Jun 1, 2015 Accepting new patients
South Broward Hospital District Current Accepting new patients
South Broward Hospital District Past Accepting new patients

Locations

20950 NE 27th Ct
Ste 203
Aventura, FL 33180
Phone (305) 933-6545

1150 N 35th Ave
Ste 170
Hollywood, FL 33021
Phone (954) 985-1500

2900 Corporate Way
#D
Miramar, FL 33025
Phone (954) 276-5581

12235 Pines Blvd
Pembroke Pines, FL 33026
Phone (954) 265-1125

801 N Flamingo Rd
Ste 11
Pembroke Pines, FL 33028

Interoperability endpoints

  • Direct secure messaging: tcandelora107833@mhsdirect.net

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 4

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

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1689754558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 CORPORATE WAY",
            "address_2": "DOOR D",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330253925",
            "telephone_number": "954-276-5685",
            "fax_number": "954-984-7074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 N FLAMINGO RD STE 11",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330281046",
            "telephone_number": "954-844-9790",
            "fax_number": "954-443-4751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANDELORA",
        "first_name": "TRACEY",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-16",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN1610012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tcandelora107833@MHSDIRECT.NET",
            "affiliation": "N",
            "endpointDescription": "MHS DSM",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "801 N Flamingo Rd Ste 11",
            "city": "Pembroke Pines",
            "state": "FL",
            "country_code": "US",
            "postal_code": "330281046",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

Verify at the official NPI Registry.