Provider Demographics
NPI:1669014783
Name:EVANS, TIANA LEIGH (MS)
Entity Type:Individual
Prefix:
First Name:TIANA
Middle Name:LEIGH
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 W HILLSBOROUGH AVE APT 314
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-5814
Mailing Address - Country:US
Mailing Address - Phone:610-463-8563
Mailing Address - Fax:
Practice Address - Street 1:3415 W HILLSBOROUGH AVE APT 314
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-5814
Practice Address - Country:US
Practice Address - Phone:610-463-8563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-09
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician