Provider Demographics
NPI:1063446136
Name:EVANS, MITTYE VICTORIA (ARNP)
Entity Type:Individual
Prefix:
First Name:MITTYE
Middle Name:VICTORIA
Last Name:EVANS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14902 WINDING CREEK CT
Mailing Address - Street 2:STE 105-C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-1640
Mailing Address - Country:US
Mailing Address - Phone:813-908-5685
Mailing Address - Fax:813-968-2526
Practice Address - Street 1:14902 WINDING CREEK CT
Practice Address - Street 2:STE 105-C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-1640
Practice Address - Country:US
Practice Address - Phone:813-908-5685
Practice Address - Fax:813-968-2526
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1559512363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner