Healthcare Provider Details

I. General information

NPI: 1932011475
Provider Name (Legal Business Name): EVAN NOAH WHYTE RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CONVOCATION WAY SUITE 100
TALLAHASSEE FL
32306-0001
US

IV. Provider business mailing address

120 CONVOCATION WAY SUITE 100
TALLAHASSEE FL
32306-0001
US

V. Phone/Fax

Practice location:
  • Phone: 850-644-2960
  • Fax:
Mailing address:
  • Phone: 850-644-2960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN9493700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: