Provider Demographics
NPI:1508179755
Name:OGLE, EVELYN FRANCES (PA-C)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:FRANCES
Last Name:OGLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-434-9564
Mailing Address - Fax:
Practice Address - Street 1:8725 N WICKHAM RD STE 200
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2240
Practice Address - Country:US
Practice Address - Phone:321-434-9564
Practice Address - Fax:321-434-9269
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA1948363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0441WOtherFL HF MEDICARE
FL002476700Medicaid