Provider Demographics
NPI:1366799223
Name:LANGFORD, CECILIA (APRN, PMHNP)
Entity type:Individual
Prefix:MS
First Name:CECILIA
Middle Name:
Last Name:LANGFORD
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:G
Other - Last Name:LANGFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:1895 KINGSLEY AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4453
Mailing Address - Country:US
Mailing Address - Phone:904-248-8926
Mailing Address - Fax:
Practice Address - Street 1:1895 KINGSLEY AVE STE 403
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4453
Practice Address - Country:US
Practice Address - Phone:904-248-8926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1829892363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101925100Medicaid