Provider Demographics
NPI:1760102487
Name:EVANGELISTA, PRECIOUS GRACE CASTRO (MSN, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:PRECIOUS GRACE
Middle Name:CASTRO
Last Name:EVANGELISTA
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 SAVANNAH PL
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-7374
Mailing Address - Country:US
Mailing Address - Phone:404-432-8380
Mailing Address - Fax:
Practice Address - Street 1:428 SAVANNAH PL
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-7374
Practice Address - Country:US
Practice Address - Phone:140-443-2838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN166173363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health