Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | APN.0994695-NP | CO |
NPI | 1053821686 |
---|---|
Provider Name | Tiffany Escobar |
First Address | Thornton, CO 80229-4365 |
Second Address | Thornton, CO 80229-4365 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2017 |
Last Update Date | 20/06/2019 |