Provider Demographics
NPI:1932860285
Name:ESCOBAR-MARSHALL, JACQUELINE MICHELLE (NP)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:MICHELLE
Last Name:ESCOBAR-MARSHALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:H
Other - Last Name:ESCOBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1419 JESUP AVE APT 6G
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-1966
Mailing Address - Country:US
Mailing Address - Phone:917-536-1041
Mailing Address - Fax:
Practice Address - Street 1:1419 JESUP AVE APT 6G
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-1966
Practice Address - Country:US
Practice Address - Phone:917-536-1041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY349001363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00000000000Medicaid