Provider Demographics
NPI:1780277897
Name:EVANS, SHANITA LADOT (APRN)
Entity type:Individual
Prefix:
First Name:SHANITA
Middle Name:LADOT
Last Name:EVANS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26606 MAGNOLIA BLVD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-8545
Mailing Address - Country:US
Mailing Address - Phone:813-907-0123
Mailing Address - Fax:813-907-5559
Practice Address - Street 1:26606 MAGNOLIA BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-8545
Practice Address - Country:US
Practice Address - Phone:813-907-0123
Practice Address - Fax:813-907-5559
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9420070163W00000X
FLAPRN11011663363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse