Healthcare Provider Details

I. General information

NPI: 1699484659
Provider Name (Legal Business Name): JOSHUA MICHAEL EVANS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 N ORLANDO AVE STE 200
WINTER PARK FL
32789-2988
US

IV. Provider business mailing address

PO BOX 102222
ATLANTA GA
30368-2222
US

V. Phone/Fax

Practice location:
  • Phone: 407-898-5452
  • Fax: 844-722-1185
Mailing address:
  • Phone: 239-274-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: