Healthcare Provider Details

I. General information

NPI: 1700633328
Provider Name (Legal Business Name): ANA EVORA RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W FAIRBANKS AVE STE 210
WINTER PARK FL
32789-4777
US

IV. Provider business mailing address

3211 ABIAKA DR
KISSIMMEE FL
34743-6045
US

V. Phone/Fax

Practice location:
  • Phone: 407-635-5565
  • Fax: 321-842-4002
Mailing address:
  • Phone: 407-342-8266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND10213
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: