Healthcare Provider Details

I. General information

NPI: 1699194944
Provider Name (Legal Business Name): JUJI TEJARES ESQUILLA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W FAIRBANKS AVE
WINTER PARK FL
32789-4756
US

IV. Provider business mailing address

1111 W FAIRBANKS AVE
WINTER PARK FL
32789-4756
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-5851
  • Fax: 321-842-1611
Mailing address:
  • Phone: 321-843-5851
  • Fax: 321-842-1611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9205665
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9205665
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: