Healthcare Provider Details

I. General information

NPI: 1801576822
Provider Name (Legal Business Name): EVAN TOKARZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17814 FALLOWFIELD DR
LUTZ FL
33549-5512
US

IV. Provider business mailing address

17814 FALLOWFIELD DR
LUTZ FL
33549-5512
US

V. Phone/Fax

Practice location:
  • Phone: 813-300-7029
  • Fax:
Mailing address:
  • Phone: 813-300-7029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW21798
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: