Provider Demographics
NPI:1851757108
Name:WAELTZ, EVI ROMA (MSN, ARNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:EVI
Middle Name:ROMA
Last Name:WAELTZ
Suffix:
Gender:F
Credentials:MSN, ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3472 FOREST HILL BLVD STE 2C
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5864
Mailing Address - Country:US
Mailing Address - Phone:561-688-8917
Mailing Address - Fax:
Practice Address - Street 1:3472 FOREST HILL BLVD STE 2C
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33406-5864
Practice Address - Country:US
Practice Address - Phone:561-688-8917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9337774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily