Provider Demographics
NPI:1629804604
Name:GARCIA ESCOBAR, MARCEL MARCIAL SR
Entity type:Individual
Prefix:
First Name:MARCEL
Middle Name:MARCIAL
Last Name:GARCIA ESCOBAR
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 MAPLE AVE N
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-1456
Mailing Address - Country:US
Mailing Address - Phone:786-915-1303
Mailing Address - Fax:
Practice Address - Street 1:207 MAPLE AVE N
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-1456
Practice Address - Country:US
Practice Address - Phone:786-915-1303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11033872363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner