Healthcare Provider Details

I. General information

NPI: 1255902946
Provider Name (Legal Business Name): JULIANA ESCUDERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14071 METROPOLIS AVE
FORT MYERS FL
33912-4330
US

IV. Provider business mailing address

14071 METROPOLIS AVE
FORT MYERS FL
33912-4330
US

V. Phone/Fax

Practice location:
  • Phone: 239-694-7546
  • Fax: 239-694-1571
Mailing address:
  • Phone: 239-694-7546
  • Fax: 239-694-1571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11027735
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: