Healthcare Provider Details

I. General information

NPI: 1568063873
Provider Name (Legal Business Name): LATASHA EVANS NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LATASHA EVANS MSN,RN, AGPCNP-C

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6232 MARKET ST
PHILADELPHIA PA
19139-2922
US

IV. Provider business mailing address

PO BOX 746722
ATLANTA GA
30374-6722
US

V. Phone/Fax

Practice location:
  • Phone: 215-444-7672
  • Fax:
Mailing address:
  • Phone: 127-339-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberSP022724
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: