Provider Demographics
NPI:1164762712
Name:ESCOBAR, VIVIANA (ARNP)
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:
Last Name:ESCOBAR
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 1:7000 SW 62ND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4716
Mailing Address - Country:US
Mailing Address - Phone:305-661-9404
Mailing Address - Fax:
Practice Address - Street 1:15680 N KENDALL DR
Practice Address - Street 2:201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1159
Practice Address - Country:US
Practice Address - Phone:305-436-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9170656363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner