Provider Demographics
NPI:1720858616
Name:FUENTES, JESSICA MARCELA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARCELA
Last Name:FUENTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:MARCELA
Other - Last Name:CEDENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:458 SHARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-5726
Mailing Address - Country:US
Mailing Address - Phone:239-227-7256
Mailing Address - Fax:
Practice Address - Street 1:1660 MEDICAL BLVD STE 300
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1497
Practice Address - Country:US
Practice Address - Phone:239-513-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9327433163WX0003X
FLAPRN11031016367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient