Provider Demographics
NPI:1538755681
Name:EVANS, TANYA N (FNP-BC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:N
Last Name:EVANS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:NICOLE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TANYA EVANS, FNP-BC
Mailing Address - Street 1:1700 S 23RD ST
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4803
Mailing Address - Country:US
Mailing Address - Phone:225-313-8867
Mailing Address - Fax:
Practice Address - Street 1:1700 S 23RD ST
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4899
Practice Address - Country:US
Practice Address - Phone:225-313-8867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty