Provider Demographics
NPI:1215956107
Name:ESCOBAR, CARMEN LUISA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MISS
First Name:CARMEN
Middle Name:LUISA
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:601 SW LAKEHURST DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2466
Mailing Address - Country:US
Mailing Address - Phone:772-873-0182
Mailing Address - Fax:
Practice Address - Street 1:2440 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4500
Practice Address - Country:US
Practice Address - Phone:772-781-2207
Practice Address - Fax:772-781-2602
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9203300363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health