Provider Demographics
NPI:1851071914
Name:PHILISTIN, EVA JOANE (APRN)
Entity Type:Individual
Prefix:
First Name:EVA JOANE
Middle Name:
Last Name:PHILISTIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD STE 800
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3923
Mailing Address - Country:US
Mailing Address - Phone:561-336-0191
Mailing Address - Fax:561-364-7785
Practice Address - Street 1:379 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3415
Practice Address - Country:US
Practice Address - Phone:561-336-0191
Practice Address - Fax:561-364-7785
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11027718363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily