Provider Demographics
NPI:1588345136
Name:ESMERALDA, DEX
Entity type:Individual
Prefix:
First Name:DEX
Middle Name:
Last Name:ESMERALDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 N STATE ROAD 7 APT 6106
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2881
Mailing Address - Country:US
Mailing Address - Phone:469-766-6524
Mailing Address - Fax:
Practice Address - Street 1:329 N STATE ROAD 7 APT 6106
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2881
Practice Address - Country:US
Practice Address - Phone:469-766-6524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9598492163WC0200X
TX1167636367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine