Healthcare Provider Details

I. General information

NPI: 1609622240
Provider Name (Legal Business Name): ADRIANA ESGUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 HIGHWAY 35 S
FOREST MS
39074-4000
US

IV. Provider business mailing address

PO BOX 306415
NASHVILLE TN
37230-6415
US

V. Phone/Fax

Practice location:
  • Phone: 601-541-4313
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number906631
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: