Healthcare Provider Details

I. General information

NPI: 1003352535
Provider Name (Legal Business Name): CECILIA IFEOMA IBE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2017
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23916 NW 83RD AVENUE
RAIFORD FL
32026-2648
US

IV. Provider business mailing address

23916 NW 83RD AVE FL 32026
RAIFORD FL
32083-1003
US

V. Phone/Fax

Practice location:
  • Phone: 904-368-2500
  • Fax:
Mailing address:
  • Phone: 904-637-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9251837
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9251837
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: