=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699894758
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ESPERANZA MARIA QUEZADA ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2007
-----------------------------------------------------
Last Update Date | 09/12/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 807 COBB CT
-----------------------------------------------------
City | WAUCHULA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33873-3161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-234-8534
-----------------------------------------------------
Fax | 863-837-4469
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 47 5TH ST NW
-----------------------------------------------------
City | WINTER HAVEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33881-4672
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-234-8534
-----------------------------------------------------
Fax | 863-837-4469
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | F381116-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | ARNP9246101
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------