Healthcare Provider Details

I. General information

NPI: 1801778675
Provider Name (Legal Business Name): SANDRA FUENTES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12485 SW 137TH AVE STE 212
MIAMI FL
33186-4217
US

IV. Provider business mailing address

8731 SW 192ND TER
CUTLER BAY FL
33157-8954
US

V. Phone/Fax

Practice location:
  • Phone: 786-909-8463
  • Fax: 305-723-2777
Mailing address:
  • Phone: 786-909-8463
  • Fax: 305-723-2777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9448537
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: