Healthcare Provider Details

I. General information

NPI: 1316754922
Provider Name (Legal Business Name): LEYSIS ESCALONA MIRABAL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14285 SW 42ND ST STE 209
MIAMI FL
33175-6416
US

IV. Provider business mailing address

13773 SW 180 TERRA
MIAMI FL
33177
US

V. Phone/Fax

Practice location:
  • Phone: 305-220-6917
  • Fax:
Mailing address:
  • Phone: 786-718-5598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11037133
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: