Healthcare Provider Details

I. General information

NPI: 1497987507
Provider Name (Legal Business Name): JENNIFER DARLENE FONSECA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. JENNIFER DARLENE FONSECA

II. Dates (important events)

Enumeration Date: 08/23/2009
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13889 WELLINGTON TRCE STE A1
WELLINGTON FL
33414-8587
US

IV. Provider business mailing address

1601 SW ARCHER RD AMBULATORY CARE DEPARTMENT
GAINESVILLE FL
32608-1135
US

V. Phone/Fax

Practice location:
  • Phone: 561-677-8865
  • Fax: 800-678-9073
Mailing address:
  • Phone: 786-566-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9250016
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: