Provider Demographics
NPI:1659708840
Name:ESTRADA, PAUL J (APRN)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:J
Last Name:ESTRADA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7504 CYPRESS GARDENS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-3200
Mailing Address - Country:US
Mailing Address - Phone:863-875-6063
Mailing Address - Fax:863-875-6086
Practice Address - Street 1:7504 CYPRESS GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-3200
Practice Address - Country:US
Practice Address - Phone:863-875-6063
Practice Address - Fax:863-875-6063
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN3141692363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN3141692OtherFLDOH