Healthcare Provider Details

I. General information

NPI: 1801006655
Provider Name (Legal Business Name): SARA EVANS MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W MAIN ST
BARTOW FL
33830-4531
US

IV. Provider business mailing address

222 W MAIN ST
BARTOW FL
33830-4531
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-3909
  • Fax: 863-293-1909
Mailing address:
  • Phone: 863-293-3909
  • Fax: 863-293-1909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME86824
License Number StateFL

VIII. Authorized Official

Name: SARA EVANS
Title or Position: OWNER
Credential: MD
Phone: 863-293-3909