Provider Demographics
NPI:1083732762
Name:LAKE-HARRIS, EVELYN (APN)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:LAKE-HARRIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:LAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10414
Mailing Address - Street 2:C O PARADIGM HEALTH
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-0414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:238 SUMMAR DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3906
Practice Address - Country:US
Practice Address - Phone:731-541-8200
Practice Address - Fax:731-935-8327
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6691363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00211926OtherRR MCARE W PARADIGM 80
TN4099612OtherBCBS W PARADIGM 80
TN3901225Medicaid
TN3901225Medicaid