Provider Demographics
NPI:1275181711
Name:IGUS, EVELIN
Entity Type:Individual
Prefix:MRS
First Name:EVELIN
Middle Name:
Last Name:IGUS
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 1:8202 MALLOW MIRROR LN
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34637-7639
Mailing Address - Country:US
Mailing Address - Phone:813-953-1704
Mailing Address - Fax:
Practice Address - Street 1:8202 MALLOW MIRROR LN
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34637-7639
Practice Address - Country:US
Practice Address - Phone:813-953-1704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider