Provider Demographics
NPI:1346871597
Name:WARREN, EVELYN ROSE
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:ROSE
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3456 NEAPTIDE PATH
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32163-6370
Mailing Address - Country:US
Mailing Address - Phone:352-804-4108
Mailing Address - Fax:
Practice Address - Street 1:3456 NEAPTIDE PATH
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-6370
Practice Address - Country:US
Practice Address - Phone:352-804-4108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9445381163W00000X
FLAPRN11006206363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse