Healthcare Provider Details

I. General information

NPI: 1760012835
Provider Name (Legal Business Name): ANGELA MARIE ESCOBAR MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1152 DOUGLAS ST
LONGVIEW WA
98632-2452
US

IV. Provider business mailing address

537 WESTWIND DR
DAVENPORT FL
33896-6613
US

V. Phone/Fax

Practice location:
  • Phone: 360-940-0880
  • Fax: 844-697-8702
Mailing address:
  • Phone: 863-259-9020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number61068559
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: