Provider Demographics
NPI:1376068882
Name:ESCOBEDO, JONATHAN LEE (MSN, RN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:LEE
Last Name:ESCOBEDO
Suffix:
Gender:M
Credentials:MSN, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-1013
Mailing Address - Country:US
Mailing Address - Phone:512-914-2738
Mailing Address - Fax:
Practice Address - Street 1:1909 E 38TH 1/2 ST STE C
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-5749
Practice Address - Country:US
Practice Address - Phone:737-262-3374
Practice Address - Fax:512-391-9703
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134760363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP134760OtherBON- APRN FNP-BC