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NPI Code Detail

MEDICARE: JAMES RAY FUENTES APRN

MEDICARE: JAMES RAY FUENTES APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse Practitioner11001340FL

General Provider Information

NPI Number : 1194386144
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES RAY FUENTES APRN
Provider Business Mailing Address
First Line : 200 AVENUE F NE
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33881-4193
Country : US
Telephone Number : 863-293-1121
Fax Number :
Provider Business Practice Location Address
First Line : 200 AVENUE F NE
Second Line :
City : WINTER HAVEN
State : FL
Zip : 33881-4193
Country : US
Telephone Number : 863-293-1121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2019
Last Update Date : 06/20/2019

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