MEDICARE: JESSICA MARCELA FUENTES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WX0003X	Inpatient Obstetric Registered Nurse	RN9327433	FL
2	367A00000X	Advanced Practice Midwife	APRN11031016	FL

General Provider Information

NPI Number	:	1720858616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARCELA FUENTES

Provider Business Mailing Address
First Line	:	458 SHARWOOD DR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34110-5726
Country	:	US
Telephone Number	:	239-227-7256
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 MEDICAL BLVD STE 300
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34110-1497
Country	:	US
Telephone Number	:	239-513-0053
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	10/31/2025

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