Healthcare Provider Details

I. General information

NPI: 1124699186
Provider Name (Legal Business Name): KEYLA LORRAINE ESCOBAR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 QUEENSBRIDGE DR
LAKE MARY FL
32746-6452
US

IV. Provider business mailing address

10140 CLEAR VISTA ST
ORLANDO FL
32832-7151
US

V. Phone/Fax

Practice location:
  • Phone: 407-951-0817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11026998
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: