MEDICARE: THEO EVANS

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1518738269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEO EVANS

Provider Business Mailing Address
First Line	:	1321 CITIZENS BLVD STE C
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-3946
Country	:	US
Telephone Number	:	352-702-3727
Fax Number	:	888-650-5089

Provider Business Practice Location Address
First Line	:	1321 CITIZENS BLVD STE C
Second Line	:
City	:	LEESBURG
State	:	FL
Zip	:	34748-3946
Country	:	US
Telephone Number	:	352-702-3727
Fax Number	:	888-650-5089

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

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	01/11/2024

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Directions to “ THEO EVANS ” Practice Location

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