Active NPI
Eileen P Fuentes, APRN
- Pediatric Nurse Practitioner
- Jacksonville, FL
National Provider Identifier
1245930502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Nurse Practitioner
- License
- 11024537
- Practice address
- 807 Childrens Way
Jacksonville, FL 32207-8426 - Phone
- (904) 697-3600
- Fax
- (904) 687-3927
- NPI assigned
- Mar 6, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | NP001351 | GA | |
| Pediatric Nurse Practitioner | 363LP0200X | 11024537 | FL | Primary |
Addresses
Primary practice location
807 Childrens Way
Jacksonville, FL 32207-8426
Mailing address
841 Prudential Dr Ste 280
Jacksonville, FL 32207-8350
Phone (904) 697-4100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11024537 | FL | MD | Pediatric Nurse Practitioner |
| NP001351 | GA | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Baptist Specialty Physicians Inc | Current | Accepting new patients | |
| Baptist Specialty Physicians Inc | Current | Accepting new patients |
Locations
841 Prudential Dr
Ste 280
Jacksonville, FL 32207
Phone (904) 202-8290
2418 E Plaza Dr
Tallahassee, FL 32308
Phone (850) 629-4861
Interoperability endpoints
- efuentes120298@direct.nemours.org
Organizations & group practices 2
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1762041600000",
"number": "1245930502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "841 PRUDENTIAL DR STE 280",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322078350",
"telephone_number": "904-697-4100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "807 CHILDRENS WAY",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322078426",
"telephone_number": "904-697-3600",
"fax_number": "904-687-3927"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUENTES",
"first_name": "EILEEN",
"middle_name": "P",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-06",
"last_updated": "2025-11-02",
"certification_date": "2025-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "GA",
"license": "NP001351",
"primary": false
},
{
"code": "363LP0200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Pediatrics",
"state": "FL",
"license": "11024537",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.