Provider Demographics
NPI:1992397194
Name:EVANS, ANDREW DAVID (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DAVID
Last Name:EVANS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 DR MARTIN LUTHER KING JR ST S UNIT 229
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1805
Mailing Address - Country:US
Mailing Address - Phone:727-539-9777
Mailing Address - Fax:
Practice Address - Street 1:5033 W LAUREL ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-3855
Practice Address - Country:US
Practice Address - Phone:813-922-8939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113612363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant