Provider Demographics
NPI:1295993251
Name:EVANS, LINDA (RD/LD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:VANALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD/LD
Mailing Address - Street 1:1102 N WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-5552
Mailing Address - Country:US
Mailing Address - Phone:813-258-6231
Mailing Address - Fax:813-258-6232
Practice Address - Street 1:1102 N WILLOW AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5552
Practice Address - Country:US
Practice Address - Phone:813-258-6231
Practice Address - Fax:813-258-6232
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1732133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL683658596Medicaid