Healthcare Provider Details

I. General information

NPI: 1093001109
Provider Name (Legal Business Name): KENDRA R. CAGNIART MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8595 SAINT JOHNS PKWY STE B107
ST AUGUSTINE FL
32092-2064
US

IV. Provider business mailing address

PO BOX 746649
ATLANTA GA
30374-6649
US

V. Phone/Fax

Practice location:
  • Phone: 904-376-3880
  • Fax: 904-618-2113
Mailing address:
  • Phone: 904-202-2092
  • Fax: 904-376-4075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101252347
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME156305
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: