Provider Demographics
NPI:1255902946
Name:ESCUDERO, JULIANA
Entity type:Individual
Prefix:
First Name:JULIANA
Middle Name:
Last Name:ESCUDERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14071 METROPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4330
Mailing Address - Country:US
Mailing Address - Phone:239-694-7546
Mailing Address - Fax:239-694-1571
Practice Address - Street 1:14071 METROPOLIS AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4330
Practice Address - Country:US
Practice Address - Phone:239-694-7546
Practice Address - Fax:239-694-1571
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily