Provider Demographics
NPI:1417385535
Name:TAMLYNN L. EVANS, PLC
Entity Type:Organization
Organization Name:TAMLYNN L. EVANS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMLYNN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,APRN, BC, NP
Authorized Official - Phone:2319-359-0002
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:650-716-4932
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:650-716-4932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704144584364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty