Provider Demographics
NPI:1316754922
Name:ESCALONA MIRABAL, LEYSIS (FNP-C)
Entity type:Individual
Prefix:
First Name:LEYSIS
Middle Name:
Last Name:ESCALONA MIRABAL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13773 SW 180 TERRA
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177
Mailing Address - Country:US
Mailing Address - Phone:786-718-5598
Mailing Address - Fax:
Practice Address - Street 1:14285 SW 42ND ST STE 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6416
Practice Address - Country:US
Practice Address - Phone:305-220-6917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-17
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11037133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine