Individual provider Active NPI

Eileen P Fuentes, APRN

  • Pediatric Nurse Practitioner
  • Jacksonville, FL
National Provider Identifier
1245930502
Registry record updated Nov 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
11024537 Issued in FL
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

Updated by the provider on Nov 2, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241113002805 FL Practitioner - Nurse Practitioner 5193259174 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
11024537FLMDPediatric Nurse Practitioner
NP001351GAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Baptist Specialty Physicians Inc CurrentSince Nov 17, 2024 Accepting new patients
Baptist Specialty Physicians Inc CurrentSince Dec 9, 2024 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

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.