Provider Demographics
NPI:1437635778
Name:ESCAMILLA, JACKIE LEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:LEE
Last Name:ESCAMILLA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-1807
Mailing Address - Country:US
Mailing Address - Phone:361-888-6782
Mailing Address - Fax:361-888-6788
Practice Address - Street 1:6717 EVERHART RD APT 3304
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2369
Practice Address - Country:US
Practice Address - Phone:361-290-9069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137966363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily