Individual provider Active NPI

Raybert Llorente Fuentes, MD

  • General Practice Physician
  • Tampa, FL
National Provider Identifier
1053969691
Registry record updated May 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
ACN1248 Issued in FL
Practice address
8201 N Dale Mabry Hwy Ste B2
Tampa, FL 33614-2795
Phone
(813) 933-7805
Fax
(844) 388-6186
NPI assigned
Aug 27, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 021528 PR
Student in an Organized Health Care Education/Training Program 390200000X
General Practice Physician 208D00000X ACN1248 FL Primary

Addresses

Primary practice location

8201 N Dale Mabry Hwy Ste B2
Tampa, FL 33614-2795

Mailing address

601 S Harbour Island Blvd Ste 200
Tampa, FL 33602-5925
Phone (813) 444-5838

Other practice location 1

315 Calle 25 NE
San Juan, PR 00920-2531
Phone (787) 523-3735

Other practice location 2

813 S Parsons Ave
Brandon, FL 33511-6063
Phone (813) 662-4841

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220331000076 FL Practitioner - General Practice 7719373737 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ACN1248FLMDGeneral Practice Physician
021528PRMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Medical Associates LLC CurrentSince Jan 30, 2023 Accepting new patients

Locations

13940 N US Highway 441
Ste 102
Lady Lake, FL 32159
Phone (352) 509-9900

3677 W Waters Ave
Tampa, FL 33614
Phone (813) 252-1225

601 S Harbour Island Blvd
Ste 200
Tampa, FL 33602
Phone (727) 322-3439

8201 N Dale Mabry Hwy
Ste B2
Tampa, FL 33614
Phone (813) 933-7805

8201 N Dale Mabry Hwy
Ste B
Tampa, FL 33614

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1566864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746057600000",
    "number": "1053969691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 S HARBOUR ISLAND BLVD STE 200",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336025925",
            "telephone_number": "813-444-5838",
            "fax_number": "833-495-7206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8201 N DALE MABRY HWY STE B2",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336142795",
            "telephone_number": "813-933-7805",
            "fax_number": "844-388-6186"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 Calle 25 NE",
            "address_purpose": "LOCATION",
            "city": "San Juan",
            "state": "PR",
            "postal_code": "009202531",
            "country_code": "US",
            "telephone_number": "787-523-3735",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "813 S Parsons Ave",
            "address_purpose": "LOCATION",
            "city": "Brandon",
            "state": "FL",
            "postal_code": "335116063",
            "country_code": "US",
            "telephone_number": "813-662-4841",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LLORENTE FUENTES",
        "first_name": "RAYBERT",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-27",
        "last_updated": "2025-05-01",
        "certification_date": "2025-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "PR",
            "license": "021528",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "FL",
            "license": "ACN1248",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.