Healthcare Provider Details

I. General information

NPI: 1235794819
Provider Name (Legal Business Name): VANNA YOUNCE ESLAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 N MCKENZIE ST
FOLEY AL
36535-2281
US

IV. Provider business mailing address

1711 N MCKENZIE ST STE 100
FOLEY AL
36535-2282
US

V. Phone/Fax

Practice location:
  • Phone: 251-943-4022
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-122280
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: