Healthcare Provider Details

I. General information

NPI: 1063895340
Provider Name (Legal Business Name): IRIS CEDENO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2015
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 HAMPTON POINT DR STE 4
ST AUGUSTINE FL
32092
US

IV. Provider business mailing address

161 HAMPTON POINT DR STE 4
ST AUGUSTINE FL
32092-3058
US

V. Phone/Fax

Practice location:
  • Phone: 904-230-0624
  • Fax:
Mailing address:
  • Phone: 904-230-0624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95027940
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberTEMP86135
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9199571
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: