Healthcare Provider Details

I. General information

NPI: 1255087581
Provider Name (Legal Business Name): ROGER ESCORCIA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 NW 14TH ST
MIAMI FL
33125-1673
US

IV. Provider business mailing address

1321 NW 14TH ST
MIAMI FL
33125-1673
US

V. Phone/Fax

Practice location:
  • Phone: 305-689-2667
  • Fax:
Mailing address:
  • Phone: 305-689-2667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11018326
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: