Healthcare Provider Details

I. General information

NPI: 1376068882
Provider Name (Legal Business Name): JONATHAN LEE ESCOBEDO MSN, RN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 E 38TH 1/2 ST STE C
AUSTIN TX
78723-5749
US

IV. Provider business mailing address

806 E 13TH ST
AUSTIN TX
78702-1013
US

V. Phone/Fax

Practice location:
  • Phone: 737-262-3374
  • Fax: 512-391-9703
Mailing address:
  • Phone: 512-914-2738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP134760
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: