MEDICARE: MS. JESSICA I ESCOBAR FNP-C

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	363LF0000X	Family Nurse Practitioner	28133197A	IN
2	363L00000X	Nurse Practitioner	71002924A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00737805	OTHER	IN	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	000000611343	OTHER	IN	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891880241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA I ESCOBAR FNP-C

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11141 PARKVIEW PLAZA DR
Second Line	:	SUITE 310
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1713
Country	:	US
Telephone Number	:	260-266-8840
Fax Number	:	260-266-8849

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	10/17/2022

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Directions to “ MS. JESSICA I ESCOBAR FNP-C” Practice Location

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