Provider Demographics
NPI:1609401751
Name:GARCIA, EVARISTO MANUEL (APRN)
Entity Type:Individual
Prefix:
First Name:EVARISTO
Middle Name:MANUEL
Last Name:GARCIA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 NW 40TH AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-5801
Mailing Address - Country:US
Mailing Address - Phone:954-615-0900
Mailing Address - Fax:
Practice Address - Street 1:1225 NW 40TH AVE UNIT 2
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-5801
Practice Address - Country:US
Practice Address - Phone:954-615-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-10
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11006446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily