Provider Demographics
NPI:1275937047
Name:ESPINA, ENRIQUITA
Entity Type:Individual
Prefix:MRS
First Name:ENRIQUITA
Middle Name:
Last Name:ESPINA
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 1:930 85TH AVE N
Mailing Address - Street 2:UNIT 105
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-3316
Mailing Address - Country:US
Mailing Address - Phone:727-460-5464
Mailing Address - Fax:
Practice Address - Street 1:930 85TH AVE N
Practice Address - Street 2:UNIT 105
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-3316
Practice Address - Country:US
Practice Address - Phone:727-460-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0010335172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker