Provider Demographics
NPI:1003839531
Name:EVANS, MORRIS C (PA-C)
Entity Type:Individual
Prefix:
First Name:MORRIS
Middle Name:C
Last Name:EVANS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4453 GREAT HARBOR LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-6138
Mailing Address - Country:US
Mailing Address - Phone:407-507-5499
Mailing Address - Fax:407-507-5499
Practice Address - Street 1:3262 VINELAND RD
Practice Address - Street 2:SUITE 102
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4839
Practice Address - Country:US
Practice Address - Phone:866-422-7367
Practice Address - Fax:407-809-5243
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9102232363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292604100Medicaid