Provider Demographics
NPI:1518324326
Name:PEMBA, EVANS (AUD)
Entity Type:Individual
Prefix:DR
First Name:EVANS
Middle Name:
Last Name:PEMBA
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7630 NW 51ST DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-1141
Mailing Address - Country:US
Mailing Address - Phone:352-672-1653
Mailing Address - Fax:
Practice Address - Street 1:1630 SE 18TH ST STE 203
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5441
Practice Address - Country:US
Practice Address - Phone:352-672-1653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY 2007231H00000X
FLAY2007231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist