Healthcare Provider Details

I. General information

NPI: 1518477231
Provider Name (Legal Business Name): EVOLUTION INSIGHT INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 W WASHINGTON ST
ORLANDO FL
32805
US

IV. Provider business mailing address

8297 CHAMPIONS GATE BLVD # 446
CHAMPIONS GATE FL
33896-8387
US

V. Phone/Fax

Practice location:
  • Phone: 321-282-1999
  • Fax: 844-839-7600
Mailing address:
  • Phone: 321-282-1999
  • Fax: 844-839-7600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VICKI HALL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 214-235-8846