Provider Demographics
NPI:1154099521
Name:EVA, BRIANNE ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIANNE
Middle Name:ELIZABETH
Last Name:EVA
Suffix:
Gender:F
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 1:1227 HUNTINGDON RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-1739
Mailing Address - Country:US
Mailing Address - Phone:720-206-9903
Mailing Address - Fax:
Practice Address - Street 1:250 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6792
Practice Address - Country:US
Practice Address - Phone:336-248-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11462363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant