Provider Demographics
NPI:1689271249
Name:EVANS, CHIQUEATA LASHAY
Entity Type:Individual
Prefix:
First Name:CHIQUEATA
Middle Name:LASHAY
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 1:304 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HAVANA
Mailing Address - State:FL
Mailing Address - Zip Code:32333-1918
Mailing Address - Country:US
Mailing Address - Phone:850-980-3482
Mailing Address - Fax:
Practice Address - Street 1:304 E 10TH AVE
Practice Address - Street 2:
Practice Address - City:HAVANA
Practice Address - State:FL
Practice Address - Zip Code:32333-1918
Practice Address - Country:US
Practice Address - Phone:850-980-3482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker