Provider Demographics
NPI:1831930189
Name:EVERGREEN WOMEN'S WELLNESS
Entity type:Organization
Organization Name:EVERGREEN WOMEN'S WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:P
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:727-209-7278
Mailing Address - Street 1:8051 N TAMIAMI TRL STE E6
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2067
Mailing Address - Country:US
Mailing Address - Phone:727-209-7278
Mailing Address - Fax:
Practice Address - Street 1:8051 N TAMIAMI TRL STE E6
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2067
Practice Address - Country:US
Practice Address - Phone:727-209-7278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVERGREEN WOMEN'S WELLNESS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-03
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty