MEDICARE: AGATTA EVANS IBCLC

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	174N00000X	Lactation Consultant (Non-RN)	L305900	FL

General Provider Information

NPI Number	:	1881375814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGATTA EVANS IBCLC

Provider Business Mailing Address
First Line	:	2410 CARNATION CT
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34289-2312
Country	:	US
Telephone Number	:	941-380-3302
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 CARNATION CT
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34289-2312
Country	:	US
Telephone Number	:	941-380-3302
Fax Number	:

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

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	07/31/2023

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