Provider Demographics
NPI:1992460976
Name:ESCOBAR, KRISTINE ALEXI (APRN)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ALEXI
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:ALEXI
Other - Last Name:GELLEZ-CABIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4354
Mailing Address - Country:US
Mailing Address - Phone:203-444-8756
Mailing Address - Fax:
Practice Address - Street 1:215 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4354
Practice Address - Country:US
Practice Address - Phone:203-444-8756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT10199363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT10199OtherCT DPH