Healthcare Provider Details

I. General information

NPI: 1427167030
Provider Name (Legal Business Name): SARA THORNBURG EVANS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W MAIN ST SUITE A
BARTOW FL
33830-4531
US

IV. Provider business mailing address

222 W MAIN ST SUITE A
BARTOW FL
33830-4531
US

V. Phone/Fax

Practice location:
  • Phone: 863-534-9383
  • Fax: 863-534-9508
Mailing address:
  • Phone: 863-534-9383
  • Fax: 863-534-9508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME86824
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: