Healthcare Provider Details

I. General information

NPI: 1912437260
Provider Name (Legal Business Name): MICHAEL ESCOBAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 01/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 MORRISON RD STE 110
BRANDON FL
33511-4849
US

IV. Provider business mailing address

PO BOX 1289
TAMPA FL
33601-1289
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-4300
  • Fax:
Mailing address:
  • Phone: 813-844-4300
  • Fax: 813-844-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9355371
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: