Healthcare Provider Details

I. General information

NPI: 1720405772
Provider Name (Legal Business Name): JENNIFER FUENTES ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

4301 EAGLE LANDING PKWY
ORANGE PARK FL
32065-2637
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-2963
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberARNP9293604
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP9293604
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: