Healthcare Provider Details

I. General information

NPI: 1952839763
Provider Name (Legal Business Name): ANN EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 NW 167TH ST
MIAMI GARDENS FL
33056-4406
US

IV. Provider business mailing address

14817 SW 164TH TER
MIAMI FL
33187-1425
US

V. Phone/Fax

Practice location:
  • Phone: 305-622-9464
  • Fax:
Mailing address:
  • Phone: 305-878-7369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ8040
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: