Provider Demographics
NPI:1568063873
Name:EVANS, LATASHA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:LATASHA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MS
Other - First Name:LATASHA
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN,RN, AGPCNP-C
Mailing Address - Street 1:7440 ROGERS AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2010
Mailing Address - Country:US
Mailing Address - Phone:610-931-0000
Mailing Address - Fax:
Practice Address - Street 1:7440 ROGERS AVE
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2010
Practice Address - Country:US
Practice Address - Phone:610-931-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022724363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology