Basic Information
| Provider Information | |||||||||
| NPI: | 1780277897 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | SHANITA | ||||||||
| MiddleName: | LADOT | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26606 MAGNOLIA BLVD | ||||||||
| Address2: | |||||||||
| City: | LUTZ | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335598545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139070123 | ||||||||
| FaxNumber: | 8139075559 | ||||||||
| Practice Location | |||||||||
| Address1: | 26606 MAGNOLIA BLVD | ||||||||
| Address2: | |||||||||
| City: | LUTZ | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335598545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139070123 | ||||||||
| FaxNumber: | 8139075559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2021 | ||||||||
| LastUpdateDate: | 03/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 9420070 | FL | N | Nursing Service Providers | Registered Nurse | 363L00000X | APRN11011663 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.