Healthcare Provider Details

I. General information

NPI: 1245829118
Provider Name (Legal Business Name): TIMOTHY RAY ESCARCEGA APRN-CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S DON ROSER DR STE F1
LAS CRUCES NM
88011-4577
US

IV. Provider business mailing address

PO BOX 2845
LAS CRUCES NM
88004-2845
US

V. Phone/Fax

Practice location:
  • Phone: 575-303-2929
  • Fax:
Mailing address:
  • Phone: 575-373-5731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number62532
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number62532
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number62532
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number62532
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: