Healthcare Provider Details

I. General information

NPI: 1578166427
Provider Name (Legal Business Name): KENIA ESCALONA - CABRERA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 11/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11041 SW 241ST ST
HOMESTEAD FL
33032-5103
US

IV. Provider business mailing address

11041 SW 241ST ST
HOMESTEAD FL
33032-5103
US

V. Phone/Fax

Practice location:
  • Phone: 786-720-7016
  • Fax:
Mailing address:
  • Phone: 786-720-7016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11010183
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: