Provider Demographics
NPI:1629555313
Name:EVANS, TONYA Y
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:Y
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N SEMORAN BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3562
Mailing Address - Country:US
Mailing Address - Phone:407-823-8421
Mailing Address - Fax:
Practice Address - Street 1:1400 N SEMORAN BLVD STE E
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3562
Practice Address - Country:US
Practice Address - Phone:407-823-8421
Practice Address - Fax:407-482-2389
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL127761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical