MEDICARE: DANIEL ESCALONA ESCALONA APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	APRN11025455	FL
2	363LF0000X	Family Nurse Practitioner	APRN11025455	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013612720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL ESCALONA ESCALONA APRN

Provider Business Mailing Address
First Line	:	9655 JASMINE BROOK CIR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34638-6028
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4160 N ARMENIA AVE STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-6453
Country	:	US
Telephone Number	:	855-226-6633
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	05/23/2023

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