Healthcare Provider Details

I. General information

NPI: 1730555343
Provider Name (Legal Business Name): NELLY ESCOBAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3821 BENERAID ST
LAND O LAKES FL
34638-7923
US

IV. Provider business mailing address

3821 BENERAID ST
LAND O LAKES FL
34638-7923
US

V. Phone/Fax

Practice location:
  • Phone: 706-201-9237
  • Fax:
Mailing address:
  • Phone: 706-201-9237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: