Provider Demographics
NPI:1053792747
Name:BREZNAU, CANDACE (MD)
Entity type:Individual
Prefix:
First Name:CANDACE
Middle Name:
Last Name:BREZNAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7050 ULMERTON RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-5003
Mailing Address - Country:US
Mailing Address - Phone:727-777-4540
Mailing Address - Fax:
Practice Address - Street 1:7050 ULMERTON RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-5003
Practice Address - Country:US
Practice Address - Phone:727-777-4540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME140554207Q00000X
VA0116028492207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine