MEDICARE: MR. PAUL J ESTRADA APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN3141692	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	APRN3141692	OTHER	FL	FLDOH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659708840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL J ESTRADA APRN

Provider Business Mailing Address
First Line	:	7504 CYPRESS GARDENS BLVD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3200
Country	:	US
Telephone Number	:	863-875-6063
Fax Number	:	863-875-6086

Provider Business Practice Location Address
First Line	:	7504 CYPRESS GARDENS BLVD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3200
Country	:	US
Telephone Number	:	863-875-6063
Fax Number	:	863-875-6063

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2013
Last Update Date	:	05/07/2021

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