Healthcare Provider Details

I. General information

NPI: 1245331123
Provider Name (Legal Business Name): EDWIN ANTHONY ESQUIBEL C-FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EDWIN ANTHONY ESQUIBEL C-FNP

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 BRIARGATE PKWY STE 445
COLORADO SPRINGS CO
80920-7839
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-364-8840
  • Fax: 719-364-3597
Mailing address:
  • Phone: 970-624-4034
  • Fax: 970-490-4347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR23821
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0993107-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: