Active NPI
Lai Fuentes Sujo, ARNP
- Nurse Practitioner
- Tampa, FL
National Provider Identifier
1740947118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 11016194
- Practice address
- 10102 Wheatley Hills CT
Tampa, FL 33615-2646 - Phone
- (813) 863-2907
- NPI assigned
- Nov 20, 2021
- Reactivated
- Mar 24, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 11016194 | FL | Primary |
Addresses
Primary practice location
10102 Wheatley Hills CT
Tampa, FL 33615-2646
Mailing address
10102 Wheatley Hills CT
Tampa, FL 33615-2646
Phone (813) 863-2907
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11016194 | FL | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1637366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648080000000",
"number": "1740947118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10102 WHEATLEY HILLS CT",
"city": "TAMPA",
"state": "FL",
"postal_code": "336152646",
"telephone_number": "813-863-2907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10102 WHEATLEY HILLS CT",
"city": "TAMPA",
"state": "FL",
"postal_code": "336152646",
"telephone_number": "813-863-2907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUENTES SUJO",
"first_name": "LAI",
"credential": "ARNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-20",
"last_updated": "2022-03-24",
"certification_date": "2022-03-24",
"deactivation_date": "2021-11-20",
"reactivation_date": "2022-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "FL",
"license": "11016194",
"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 Mar 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.