Healthcare Provider Details

I. General information

NPI: 1679835797
Provider Name (Legal Business Name): JENNIFER A ESCALANTE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 06/25/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD STE 650
MIAMI BEACH FL
33140-2877
US

IV. Provider business mailing address

4302 ALTON RD STE 650
MIAMI BEACH FL
33140-2877
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2543
  • Fax: 305-674-2996
Mailing address:
  • Phone: 305-674-2543
  • Fax: 305-674-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9106522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: