Basic Information
| Provider Information | |||||||||
| NPI: | 1083856256 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | LURENA | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10000 W COLONIAL DR | ||||||||
| Address2: | |||||||||
| City: | OCOEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347613400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218431378 | ||||||||
| FaxNumber: | 3218435177 | ||||||||
| Practice Location | |||||||||
| Address1: | 10000 W COLONIAL DR | ||||||||
| Address2: | |||||||||
| City: | OCOEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347613400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3218431378 | ||||||||
| FaxNumber: | 3218435177 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2009 | ||||||||
| LastUpdateDate: | 02/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | F340766-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | APRN9264055 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LA2200X | APRN9264055 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 002368700 | 05 | FL | MEDICAID |