Provider Demographics
NPI:1841604345
Name:JOSE, ESHA (FNP)
Entity Type:Individual
Prefix:
First Name:ESHA
Middle Name:
Last Name:JOSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:3 E GOLF RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4001
Practice Address - Country:US
Practice Address - Phone:800-323-8622
Practice Address - Fax:224-225-0358
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.380190163W00000X
TX890704163W00000X
TXAP130513363LF0000X
IL209.011444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX890704OtherRN LICENSE
IL209.011444OtherFNP LICENSE
TXAP130513OtherTEXAS FNP LICENSE