Healthcare Provider Details

I. General information

NPI: 1649104589
Provider Name (Legal Business Name): ANGELA EVERSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3872 E BART ST
GILBERT AZ
85295-0260
US

IV. Provider business mailing address

3872 E BART ST
GILBERT AZ
85295-0260
US

V. Phone/Fax

Practice location:
  • Phone: 602-480-7207
  • Fax:
Mailing address:
  • Phone: 602-480-7207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number340554
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: