Healthcare Provider Details

I. General information

NPI: 1669032751
Provider Name (Legal Business Name): FERNANDO FUENTES EIMIL APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 SW 74TH ST STE 205
MIAMI FL
33143-5150
US

IV. Provider business mailing address

14750 NW 77TH CT STE 100
MIAMI LAKES FL
33016-1507
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-8691
  • Fax:
Mailing address:
  • Phone: 786-758-3152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06191046
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11002932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: