Healthcare Provider Details

I. General information

NPI: 1386049740
Provider Name (Legal Business Name): MRS. ANDREA MICHELLE ESCAMILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2014
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5607 TIMBER BARK
SAN ANTONIO TX
78250-4241
US

IV. Provider business mailing address

5607 TIMBER BARK
SAN ANTONIO TX
78250-4241
US

V. Phone/Fax

Practice location:
  • Phone: 210-837-2692
  • Fax:
Mailing address:
  • Phone: 210-837-2692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP126963
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number794792
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: