Provider Demographics
NPI:1164803227
Name:EVANS, CARLY RENE (ARNP)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:RENE
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 1:3042 PLAZA TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-2810
Mailing Address - Country:US
Mailing Address - Phone:407-619-3262
Mailing Address - Fax:
Practice Address - Street 1:5467 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-6332
Practice Address - Country:US
Practice Address - Phone:407-324-3036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9238240363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily