Healthcare Provider Details

I. General information

NPI: 1235085259
Provider Name (Legal Business Name): ROBIN EVANSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11180 WARNER AVE # A380
FOUNTAIN VALLEY CA
92708-7501
US

IV. Provider business mailing address

28866 ROCKPORT DR
LAGUNA NIGUEL CA
92677-4671
US

V. Phone/Fax

Practice location:
  • Phone: 714-596-5557
  • Fax:
Mailing address:
  • Phone: 626-864-8144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95038786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: