Provider Demographics
NPI:1679133763
Name:FUENTES, SYDALG (FNP-BC)
Entity type:Individual
Prefix:
First Name:SYDALG
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 SW 142ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3019
Mailing Address - Country:US
Mailing Address - Phone:786-800-1925
Mailing Address - Fax:
Practice Address - Street 1:7000 SW 62ND AVE STE 210
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4719
Practice Address - Country:US
Practice Address - Phone:786-798-8292
Practice Address - Fax:786-536-7026
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF06191766363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily