Healthcare Provider Details

I. General information

NPI: 1689544157
Provider Name (Legal Business Name): JENNIFER ESCOBAR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1096
US

IV. Provider business mailing address

1611 NW 12TH AVE
MIAMI FL
33136-1096
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberAPRN11042734
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: