Provider Demographics
NPI:1750500278
Name:EVANS, ROGER (RN)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34106-0429
Mailing Address - Country:US
Mailing Address - Phone:239-732-2697
Mailing Address - Fax:239-774-5653
Practice Address - Street 1:3301 TAMIAMI TRL E
Practice Address - Street 2:BUILDING H
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-3969
Practice Address - Country:US
Practice Address - Phone:239-732-2697
Practice Address - Fax:239-774-5653
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1074892163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health