Healthcare Provider Details

I. General information

NPI: 1801828439
Provider Name (Legal Business Name): EVAN COLLINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/29/2025
Certification Date: 03/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3498 NW FEDERAL HWY
JENSEN BEACH FL
34957-4441
US

IV. Provider business mailing address

3498 NW FEDERAL HWY
JENSEN BEACH FL
34957-4441
US

V. Phone/Fax

Practice location:
  • Phone: 772-219-1080
  • Fax: 772-219-1070
Mailing address:
  • Phone: 772-219-1080
  • Fax: 772-219-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberME0053310
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: