Provider Demographics
NPI:1518350461
Name:ESCOBAR, FABIOLA (NP)
Entity type:Individual
Prefix:
First Name:FABIOLA
Middle Name:
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 FOREST RIDGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-8228
Mailing Address - Country:US
Mailing Address - Phone:817-354-2680
Mailing Address - Fax:817-510-5927
Practice Address - Street 1:1924 FOREST RIDGE DR STE B
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-8228
Practice Address - Country:US
Practice Address - Phone:817-354-2680
Practice Address - Fax:817-510-5927
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126770363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health