Basic Information
| Provider Information | |||||||||
| NPI: | 1518324326 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEMBA | ||||||||
| FirstName: | EVANS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1521 NW 40TH DR | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326054673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526721653 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2485 PINELLAS PL | ||||||||
| Address2: | |||||||||
| City: | THE VILLAGES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321632703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526741720 | ||||||||
| FaxNumber: | 3526748920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2016 | ||||||||
| LastUpdateDate: | 04/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AY 2007 | FL | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.