Healthcare Provider Details

I. General information

NPI: 1932872959
Provider Name (Legal Business Name): CARMEN JULIA ESCABA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4208 EVERGREEN LN STE 214
ANNANDALE VA
22003-3254
US

IV. Provider business mailing address

5748 CARIBBEAN CT
HAYMARKET VA
20169-2557
US

V. Phone/Fax

Practice location:
  • Phone: 703-543-5630
  • Fax:
Mailing address:
  • Phone: 703-864-0921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024182263
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: