Provider Demographics
NPI:1255763678
Name:EVATZ, CARRIE NICOLE (ANP, BC)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:NICOLE
Last Name:EVATZ
Suffix:
Gender:F
Credentials:ANP, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24508 STAR VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-3175
Mailing Address - Country:US
Mailing Address - Phone:586-873-8102
Mailing Address - Fax:
Practice Address - Street 1:5456 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-5110
Practice Address - Country:US
Practice Address - Phone:586-977-7246
Practice Address - Fax:586-977-1492
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704253160363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health