Provider Demographics
NPI:1770978009
Name:BARTON, EVELYN
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:BARTON
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 1:124 BELLAMY TRL
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-6483
Mailing Address - Country:US
Mailing Address - Phone:772-589-7328
Mailing Address - Fax:772-589-7328
Practice Address - Street 1:124 BELLAMY TRL
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-6483
Practice Address - Country:US
Practice Address - Phone:772-589-7328
Practice Address - Fax:772-589-7328
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL274416050310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility