Healthcare Provider Details

I. General information

NPI: 1609401751
Provider Name (Legal Business Name): EVARISTO MANUEL GARCIA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2020
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S HIATUS RD
PEMBROKE PINES FL
33025-3617
US

IV. Provider business mailing address

1500 S HIATUS RD
PEMBROKE PINES FL
33025-3617
US

V. Phone/Fax

Practice location:
  • Phone: 954-438-4000
  • Fax:
Mailing address:
  • Phone: 954-438-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11006446
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: