Provider Demographics
NPI:1902475841
Name:ESCALANTE, JACQUELINE (DO)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:ESCALANTE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 WELLS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2982
Mailing Address - Country:US
Mailing Address - Phone:904-778-3389
Mailing Address - Fax:
Practice Address - Street 1:7855 ARGYLE FOREST BLVD STE 601
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-7704
Practice Address - Country:US
Practice Address - Phone:904-778-3389
Practice Address - Fax:904-778-3395
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-24
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS20304207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine