Provider Demographics
NPI:1336113216
Name:EVANS, TAMLYNN (APRN, BC, NP)
Entity Type:Individual
Prefix:
First Name:TAMLYNN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:APRN, BC, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W FRONT ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2259
Mailing Address - Country:US
Mailing Address - Phone:231-935-9002
Mailing Address - Fax:
Practice Address - Street 1:401 W FRONT ST
Practice Address - Street 2:SUITE 8
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2259
Practice Address - Country:US
Practice Address - Phone:231-935-9002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704144584363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MITE144584Other3RD PARTY IDENTIFIER
MI4704144584OtherSTATE LICENSE NUMBER
MIME0963416OtherDEA NUMBER
MION43930Medicare ID - Type UnspecifiedMEDICARE ID # FOR MBCMH
MITE144584Other3RD PARTY IDENTIFIER