Provider Demographics
NPI:1992548754
Name:ESCOBAR, MARITZA ESMERALDA
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:ESMERALDA
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3431 NEW HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-1918
Mailing Address - Country:US
Mailing Address - Phone:980-263-8471
Mailing Address - Fax:
Practice Address - Street 1:3431 NEW HAMPSHIRE DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-1918
Practice Address - Country:US
Practice Address - Phone:980-263-8471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCESCO-Q0HC8363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner