Healthcare Provider Details

I. General information

NPI: 1073869210
Provider Name (Legal Business Name): CARLA M EVANS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2012
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 COMMONWEALTH AVE
WILLIAMSBURG VA
23185-5125
US

IV. Provider business mailing address

11844 ROCK LANDING DR STE B
NEWPORT NEWS VA
23606-4202
US

V. Phone/Fax

Practice location:
  • Phone: 757-259-9466
  • Fax:
Mailing address:
  • Phone: 757-873-0161
  • Fax: 757-873-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCAPRN00047
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0411035
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001107154
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN35540
License Number StateRI
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN00047
License Number StateRI
# 6
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN00047
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: