Healthcare Provider Details

I. General information

NPI: 1285642488
Provider Name (Legal Business Name): EVAN ARLENE MIGHTY A.R.N.P., C.N.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 FRIST BLVD SUITE 3
FORT PIERCE FL
34950-4839
US

IV. Provider business mailing address

2401 FRIST BLVD SUITE 3
FORT PIERCE FL
34950-4839
US

V. Phone/Fax

Practice location:
  • Phone: 772-429-3400
  • Fax: 772-429-3410
Mailing address:
  • Phone: 772-429-3400
  • Fax: 772-429-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP9231838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: