Healthcare Provider Details

I. General information

NPI: 1114130622
Provider Name (Legal Business Name): LYNDA G EVANS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 SW 13TH ST ATTN: HR DEPARTMENT
GAINESVILLE FL
32608-4006
US

IV. Provider business mailing address

4300 SW 13TH ST ATTN: HR DEPARTMENT
GAINESVILLE FL
32608-4006
US

V. Phone/Fax

Practice location:
  • Phone: 352-374-5600
  • Fax: 352-374-5608
Mailing address:
  • Phone: 352-374-5600
  • Fax: 352-374-5608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 5366
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: