MEDICARE: MR. ROBERT FRANK EVANS M.ED,LIC SCH PSY RET

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	103TS0200X	School Psychologist	PSY290 RETIRED	FL
2	174400000X	Specialist	PSY290 RETIRED	FL

General Provider Information

NPI Number	:	1699067348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT FRANK EVANS M.ED,LIC SCH PSY RET

Provider Business Mailing Address
First Line	:	6505 FINCANNON RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-1517
Country	:	US
Telephone Number	:	904-743-1885
Fax Number	:	904-743-1885

Provider Business Practice Location Address
First Line	:	6505 FINCANNON RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-1517
Country	:	US
Telephone Number	:	904-743-1885
Fax Number	:	904-743-1885

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

Provider Enumeration Date	:	05/12/2011
Last Update Date	:	05/12/2011

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