Basic Information
Provider Information
NPI: 1942713797
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ESCOTO
FirstName: ANIELKA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 3725
Address2:  
City: AUGUSTA
State: GA
PostalCode: 309143725
CountryCode: US
TelephoneNumber: 7068639595
FaxNumber: 7068688375
Practice Location
Address1: 11750 BIRD RD
Address2:  
City: MIAMI
State: FL
PostalCode: 331753530
CountryCode: US
TelephoneNumber: 7068639595
FaxNumber: 7068688375
Other Information
ProviderEnumerationDate: 11/14/2017
LastUpdateDate: 04/06/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XARNP9283850FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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