Provider Demographics
NPI:1912557620
Name:LOUIMA, EVENS (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:EVENS
Middle Name:
Last Name:LOUIMA
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 NW 49TH AVE
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-7754
Mailing Address - Country:US
Mailing Address - Phone:754-265-1466
Mailing Address - Fax:
Practice Address - Street 1:1921 NW 49TH AVE
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-7754
Practice Address - Country:US
Practice Address - Phone:754-265-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-14
Last Update Date:2019-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR444-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant