Healthcare Provider Details

I. General information

NPI: 1902475841
Provider Name (Legal Business Name): JACQUELINE ESCALANTE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 ARGYLE FOREST BLVD STE 601
JACKSONVILLE FL
32244-7704
US

IV. Provider business mailing address

705 WELLS RD STE 300
ORANGE PARK FL
32073-2982
US

V. Phone/Fax

Practice location:
  • Phone: 904-778-3389
  • Fax: 904-778-3395
Mailing address:
  • Phone: 904-778-3389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS20304
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: