Healthcare Provider Details

I. General information

NPI: 1023390937
Provider Name (Legal Business Name): JULISSA JIMENEZ ESCORCIA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12295 TAFT ST
PEMBROKE PINES FL
33026-1900
US

IV. Provider business mailing address

2900 CORPORATE WAY DOOR D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-447-7771
  • Fax: 954-447-7505
Mailing address:
  • Phone: 954-276-5685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3411362
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN3411362
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: