Healthcare Provider Details

I. General information

NPI: 1659825032
Provider Name (Legal Business Name): NICOLE ESQUEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 NW 107TH AVE
SWEETWATER FL
33172-2732
US

IV. Provider business mailing address

14552 SW 152ND PL
MIAMI FL
33196-2805
US

V. Phone/Fax

Practice location:
  • Phone: 786-209-5992
  • Fax:
Mailing address:
  • Phone: 786-209-5992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: