Provider Demographics
NPI:1003273947
Name:SL EVANS LLC
Entity Type:Organization
Organization Name:SL EVANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:561-213-9373
Mailing Address - Street 1:32 COUNTRY LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6200
Mailing Address - Country:US
Mailing Address - Phone:561-213-9373
Mailing Address - Fax:561-423-2688
Practice Address - Street 1:32 COUNTRY LAKE CIR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-6200
Practice Address - Country:US
Practice Address - Phone:561-213-9373
Practice Address - Fax:561-423-2688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102141363AS0400X
FLARNP3280102363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty