Healthcare Provider Details

I. General information

NPI: 1730014119
Provider Name (Legal Business Name): AIDELY FUENTES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 NW 114TH AVE
DORAL FL
33178-4374
US

IV. Provider business mailing address

4005 NW 114TH AVE
DORAL FL
33178-4374
US

V. Phone/Fax

Practice location:
  • Phone: 305-591-5691
  • Fax:
Mailing address:
  • Phone: 305-591-5691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11048713
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9482005
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: