Provider Demographics
NPI:1063189223
Name:ESCOBAR, NICOLE RENEE E (DNP)
Entity type:Individual
Prefix:
First Name:NICOLE RENEE
Middle Name:E
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-3402
Mailing Address - Country:US
Mailing Address - Phone:626-898-8000
Mailing Address - Fax:
Practice Address - Street 1:633 ROYAL VIEW ST
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1346
Practice Address - Country:US
Practice Address - Phone:626-677-0472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95176802163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty