Healthcare Provider Details

I. General information

NPI: 1114976107
Provider Name (Legal Business Name): LUCILE RITA CUENOT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3627 UNIVERSITY BLVD S
JACKSONVILLE FL
32216-4230
US

IV. Provider business mailing address

3627 UNIVERSITY BLVD S STE 300
JACKSONVILLE FL
32216-4294
US

V. Phone/Fax

Practice location:
  • Phone: 904-396-0300
  • Fax: 904-396-3039
Mailing address:
  • Phone: 904-396-0300
  • Fax: 904-396-3039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP 637382
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: