Healthcare Provider Details

I. General information

NPI: 1487455523
Provider Name (Legal Business Name): SAMANTHA CARDENAS PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 REYKO RD STE 100
JACKSONVILLE FL
32207-2828
US

IV. Provider business mailing address

2055 REYKO RD STE 100
JACKSONVILLE FL
32207-2828
US

V. Phone/Fax

Practice location:
  • Phone: 904-648-8200
  • Fax: 904-253-3270
Mailing address:
  • Phone: 904-648-8200
  • Fax: 904-253-3270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN9502722
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11042392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: