1215956107 NPI number — MISS CARMEN LUISA ESCOBAR NURSE PRACTITIONER

Table of content: MISS CARMEN LUISA ESCOBAR NURSE PRACTITIONER (NPI 1215956107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215956107 NPI number — MISS CARMEN LUISA ESCOBAR NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESCOBAR
Provider First Name:
CARMEN
Provider Middle Name:
LUISA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215956107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 SW LAKEHURST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ST LUCIE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34983-2466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-873-0182
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2440 SE FEDERAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34994-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-781-2207
Provider Business Practice Location Address Fax Number:
772-781-2602
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  ARNP9203300 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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