Provider Demographics
NPI:1790653756
Name:ESCOBAR, ANGEL (PA-C)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 WAGONWHEEL RD
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-7830
Mailing Address - Country:US
Mailing Address - Phone:619-204-1571
Mailing Address - Fax:
Practice Address - Street 1:3100 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:PA
Practice Address - Zip Code:17057-3548
Practice Address - Country:US
Practice Address - Phone:717-948-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-29
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA067037363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical