Provider Demographics
NPI:1417494840
Name:MOEN, RENATA ARAUJO (APRN)
Entity Type:Individual
Prefix:
First Name:RENATA
Middle Name:ARAUJO
Last Name:MOEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SAN MARCO BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8567
Mailing Address - Country:US
Mailing Address - Phone:904-253-6910
Mailing Address - Fax:904-253-6964
Practice Address - Street 1:14540 OLD SAINT AUGUSTINE RD STE 2403
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-7418
Practice Address - Country:US
Practice Address - Phone:904-253-6910
Practice Address - Fax:904-253-6964
Is Sole Proprietor?:No
Enumeration Date:2017-01-24
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9316187363L00000X
FLAPRN9316187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101594800Medicaid