Provider Demographics
NPI:1083981260
Name:EVANS, DALLAS LAMAR (ARNP)
Entity Type:Individual
Prefix:
First Name:DALLAS
Middle Name:LAMAR
Last Name:EVANS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6742 RHODE ISLAND DRIVE WEST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-1436
Mailing Address - Country:US
Mailing Address - Phone:904-380-0346
Mailing Address - Fax:904-768-1226
Practice Address - Street 1:6550 N WICKHAM RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2038
Practice Address - Country:US
Practice Address - Phone:321-751-9506
Practice Address - Fax:321-751-9505
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9175957363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health