Healthcare Provider Details

I. General information

NPI: 1841082575
Provider Name (Legal Business Name): ARIENNA WREN CANONICO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 N NARCOOSSEE RD
SAINT CLOUD FL
34771-8784
US

IV. Provider business mailing address

178 RIVERWOODS DR
CHULUOTA FL
32766-9203
US

V. Phone/Fax

Practice location:
  • Phone: 407-556-9898
  • Fax:
Mailing address:
  • Phone: 407-236-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number9470965
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11039969
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: