MEDICARE: ESENCIAL WALK-IN & PRIMARY CARE CLINIC, LLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1972285542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESENCIAL WALK-IN & PRIMARY CARE CLINIC, LLC

Provider Business Mailing Address
First Line	:	630 N SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3330
Country	:	US
Telephone Number	:	407-635-0074
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 N SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3330
Country	:	US
Telephone Number	:	407-635-0074
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL PROVIDER
Name	:	CIARA M. RIOS
Credential	:	FNP
Telephone Number	:	407-635-0074

Provider Enumeration Date	:	08/03/2023
Last Update Date	:	03/08/2024

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