Healthcare Provider Details

I. General information

NPI: 1619831609
Provider Name (Legal Business Name): JESSE CUEVAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 HIGHLANDS PLACE DR
LAKELAND FL
33813-2120
US

IV. Provider business mailing address

4626 HIGHLANDS PLACE DR
LAKELAND FL
33813-2120
US

V. Phone/Fax

Practice location:
  • Phone: 863-899-9468
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberRN9535048
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: