Healthcare Provider Details

I. General information

NPI: 1417385535
Provider Name (Legal Business Name): TAMLYNN L. EVANS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2013
Last Update Date: 10/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W FRONT ST SUITE #8
TRAVERSE CITY MI
49684-2259
US

IV. Provider business mailing address

401 W FRONT ST SUITE #8
TRAVERSE CITY MI
49684-2259
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-9002
  • Fax: 650-716-4932
Mailing address:
  • Phone: 231-935-9002
  • Fax: 650-716-4932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number4704144584
License Number StateMI

VIII. Authorized Official

Name: TAMLYNN LEIGH EVANS
Title or Position: OWNER
Credential: MS,APRN, BC, NP
Phone: 23193590002