Provider Demographics
NPI:1699894758
Name:QUEZADA, ESPERANZA MARIA (ARNP)
Entity type:Individual
Prefix:
First Name:ESPERANZA
Middle Name:MARIA
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4672
Mailing Address - Country:US
Mailing Address - Phone:866-234-8534
Mailing Address - Fax:863-837-4469
Practice Address - Street 1:807 COBB CT
Practice Address - Street 2:
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-3161
Practice Address - Country:US
Practice Address - Phone:866-234-8534
Practice Address - Fax:863-837-4469
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF381116-1363LP0200X
FLARNP9246101363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL308953300Medicaid