Healthcare Provider Details

I. General information

NPI: 1447014071
Provider Name (Legal Business Name): ERICK ESPINOZA DNP-FNP STUDENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 MOLAKI DR
MERRITT ISLAND FL
32953-3256
US

IV. Provider business mailing address

1085 MOLAKI DR
MERRITT ISLAND FL
32953-3256
US

V. Phone/Fax

Practice location:
  • Phone: 352-888-0218
  • Fax:
Mailing address:
  • Phone: 352-888-0218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN9400542
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: