Healthcare Provider Details

I. General information

NPI: 1083589774
Provider Name (Legal Business Name): GINNY REBECCA EVERTON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4591 E HIGHWAY 20 STE 202
NICEVILLE FL
32578-8845
US

IV. Provider business mailing address

4591 E HIGHWAY 20 STE 202
NICEVILLE FL
32578-8845
US

V. Phone/Fax

Practice location:
  • Phone: 850-899-2233
  • Fax: 850-520-9005
Mailing address:
  • Phone: 850-899-2233
  • Fax: 850-520-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11042806
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: