Provider Demographics
NPI:1962015198
Name:WOYCITZKY, EVONNE C
Entity Type:Individual
Prefix:
First Name:EVONNE
Middle Name:C
Last Name:WOYCITZKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 TREE SWALLOW DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-9000
Mailing Address - Country:US
Mailing Address - Phone:831-601-0251
Mailing Address - Fax:
Practice Address - Street 1:426 TREE SWALLOW DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-9000
Practice Address - Country:US
Practice Address - Phone:831-601-0251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-27
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96763225700000X
FLMA82429225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist