Provider Demographics
NPI:1770353146
Name:MATHIS, EVELYN (APRN,PMHNP-BC,FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:
Last Name:MATHIS
Suffix:
Gender:F
Credentials:APRN,PMHNP-BC,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 PALM TRACE LANDINGS DR APT 104
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-1858
Mailing Address - Country:US
Mailing Address - Phone:954-381-6839
Mailing Address - Fax:
Practice Address - Street 1:5900 PALM TRACE LANDINGS DR APT 104
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-1858
Practice Address - Country:US
Practice Address - Phone:954-381-6839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018030363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily