Provider Demographics
NPI:1801204193
Name:EVANS, ERICA R (CNP)
Entity type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:R
Last Name:EVANS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:R
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19156 MEADOW PINE DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3609
Mailing Address - Country:US
Mailing Address - Phone:404-370-2158
Mailing Address - Fax:
Practice Address - Street 1:2927 PEARSON JAMES PLACE
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559
Practice Address - Country:US
Practice Address - Phone:813-428-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-30
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9556166163W00000X
FL11002496363LF0000X
FLAPRN11002496363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117895500Medicaid