Healthcare Provider Details

I. General information

NPI: 1760952857
Provider Name (Legal Business Name): EVERARDO CUEVAS-ESPINOZA FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2018
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 INCA LN
RINGGOLD VA
24586
US

IV. Provider business mailing address

525 INCA LN
RINGGOLD VA
24586
US

V. Phone/Fax

Practice location:
  • Phone: 434-222-4803
  • Fax:
Mailing address:
  • Phone: 434-222-4803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024176849
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: