Provider Demographics
NPI:1235487000
Name:MCALLISTER, EVELLAR MARISSA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:EVELLAR
Middle Name:MARISSA
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:EVELLAR
Other - Middle Name:MARISSA
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1064 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BARTOW
Mailing Address - State:FL
Mailing Address - Zip Code:33830
Mailing Address - Country:US
Mailing Address - Phone:863-519-9797
Mailing Address - Fax:863-533-8723
Practice Address - Street 1:1064 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BARTOW
Practice Address - State:FL
Practice Address - Zip Code:33830
Practice Address - Country:US
Practice Address - Phone:863-519-9797
Practice Address - Fax:863-533-8723
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9275053363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health