Healthcare Provider Details

I. General information

NPI: 1285551374
Provider Name (Legal Business Name): MIA V EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 GLADES RD
BOCA RATON FL
33431-7205
US

IV. Provider business mailing address

5550 GLADES RD
BOCA RATON FL
33431-7205
US

V. Phone/Fax

Practice location:
  • Phone: 561-299-1236
  • Fax:
Mailing address:
  • Phone: 561-299-1236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW23399
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: