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General NPI Number Information
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NPI Number | 1245930502
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Entity Type | Individual
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Provider Name | EILEEN P FUENTES APRN
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Gender | Female
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 11/02/2025
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Provider Practice Location Address
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Address Line | 807 CHILDRENS WAY
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8426
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Country | US
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Telephone | 904-697-3600
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Fax | 904-687-3927
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Provider Business Mailing Address
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Address Line | 841 PRUDENTIAL DR STE 280
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8350
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Country | US
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Telephone | 904-697-4100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | NP001351
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 11024537
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License Number State | FL
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