Provider Demographics
NPI:1336603372
Name:QUEVEDO-ENRIQUEZ, EVELYN (NP)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:QUEVEDO-ENRIQUEZ
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 1:1007 N 31ST RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5516
Mailing Address - Country:US
Mailing Address - Phone:732-608-3618
Mailing Address - Fax:
Practice Address - Street 1:110 E BROWARD BLVD STE 820
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-3549
Practice Address - Country:US
Practice Address - Phone:954-712-8860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9369584363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty