Healthcare Provider Details

I. General information

NPI: 1437635778
Provider Name (Legal Business Name): JACKIE LEE ESCAMILLA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 05/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6717 EVERHART RD APT 3304
CORPUS CHRISTI TX
78413-2369
US

IV. Provider business mailing address

2502 MORGAN AVE
CORPUS CHRISTI TX
78405-1807
US

V. Phone/Fax

Practice location:
  • Phone: 361-290-9069
  • Fax:
Mailing address:
  • Phone: 361-888-6782
  • Fax: 361-888-6788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP137966
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: