MEDICARE: LINDA EVANS RD/LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	1732	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295993251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA EVANS RD/LD

Provider Business Mailing Address
First Line	:	1102 N WILLOW AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5552
Country	:	US
Telephone Number	:	813-258-6231
Fax Number	:	813-258-6232

Provider Business Practice Location Address
First Line	:	1102 N WILLOW AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5552
Country	:	US
Telephone Number	:	813-258-6231
Fax Number	:	813-258-6232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	01/14/2015

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