Provider Demographics
NPI:1093160301
Name:EVANS, ABIGAIL (NP)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1536 SUNRISE PLAZA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34714-6204
Mailing Address - Country:US
Mailing Address - Phone:321-326-7516
Mailing Address - Fax:321-517-2999
Practice Address - Street 1:1536 SUNRISE PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34714-6204
Practice Address - Country:US
Practice Address - Phone:321-326-7516
Practice Address - Fax:321-517-2999
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704284752363LF0000X
FLAPRN11011204363LF0000X, 363LP0808X
AK232388363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily