Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kandyce Lopez, PA

Individual provider Physician Assistant · NPI 1083479372

Kandyce Lopez, PA is a Physician Assistant in Venice, Florida. Qualified in 2023, 3 years ago. Practices with Millennium Physician Group LLC, a 970-clinician group. Licensed in Florida.

Years since qualifying
3
Licensed in
FL
In the registry since
2024
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

8036 S Tamiami Trl
Venice, FL 34293-5113
Phone: (941) 244-4300
Fax: (941) 244-4380
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA9118394 (FL)

Record details

NPI number1083479372
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedFebruary 16, 2024
Last updated in NPPESNovember 14, 2025
Certification dateNovember 14, 2025
Mailing address2675 Winkler Ave Ste 200, Fort Myers, FL 33901-9328

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Millennium Physician Group Llc — 970 clinicians
Accepts Medicare assignment Not indicated

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