Healthcare Provider Details

I. General information

NPI: 1720858616
Provider Name (Legal Business Name): JESSICA MARCELA FUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA MARCELA CEDENO

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 MEDICAL BLVD STE 300
NAPLES FL
34110-1497
US

IV. Provider business mailing address

458 SHARWOOD DR
NAPLES FL
34110-5726
US

V. Phone/Fax

Practice location:
  • Phone: 239-513-0053
  • Fax:
Mailing address:
  • Phone: 239-227-7256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN9327433
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN11031016
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: