Healthcare Provider Details

I. General information

NPI: 1659573673
Provider Name (Legal Business Name): AMY SUZAN ESQUEDA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 JAMES CASEY ST STE. 1A
AUSTIN TX
78745-1251
US

IV. Provider business mailing address

4310 JAMES CASEY ST STE. 1A
AUSTIN TX
78745-1251
US

V. Phone/Fax

Practice location:
  • Phone: 512-445-2833
  • Fax: 512-445-4121
Mailing address:
  • Phone: 512-445-2833
  • Fax: 512-445-4121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number583612 TX
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: