Healthcare Provider Details

I. General information

NPI: 1417550336
Provider Name (Legal Business Name): MARIANA LUCIA ESCALONA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2020
Last Update Date: 11/21/2020
Certification Date: 11/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 NW 58TH ST
DORAL FL
33178-2735
US

IV. Provider business mailing address

19400 NE 18TH PL
NORTH MIAMI BEACH FL
33179-3640
US

V. Phone/Fax

Practice location:
  • Phone: 786-953-4330
  • Fax:
Mailing address:
  • Phone: 786-657-5284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11009802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: