Healthcare Provider Details

I. General information

NPI: 1336658103
Provider Name (Legal Business Name): NENA SHERYL MORDEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHETSTONE PL STE 205
ST AUGUSTINE FL
32086-5775
US

IV. Provider business mailing address

100 WHETSTONE PL STE 205
ST AUGUSTINE FL
32086-5775
US

V. Phone/Fax

Practice location:
  • Phone: 904-343-5281
  • Fax: 904-592-5369
Mailing address:
  • Phone: 904-343-5281
  • Fax: 904-592-5369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9313384
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: