Provider Demographics
NPI:1902391329
Name:ESCOFFERY, ROSEMARIE COLLEEN
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:COLLEEN
Last Name:ESCOFFERY
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 1:12051 SKIMMER AVE
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34614-1028
Mailing Address - Country:US
Mailing Address - Phone:443-852-2734
Mailing Address - Fax:
Practice Address - Street 1:12051 SKIMMER AVE
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34614-1028
Practice Address - Country:US
Practice Address - Phone:443-852-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities