Healthcare Provider Details

I. General information

NPI: 1699894758
Provider Name (Legal Business Name): ESPERANZA MARIA QUEZADA ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 COBB CT
WAUCHULA FL
33873-3161
US

IV. Provider business mailing address

47 5TH ST NW
WINTER HAVEN FL
33881-4672
US

V. Phone/Fax

Practice location:
  • Phone: 866-234-8534
  • Fax: 863-837-4469
Mailing address:
  • Phone: 866-234-8534
  • Fax: 863-837-4469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF381116-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP9246101
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: