Healthcare Provider Details

I. General information

NPI: 1881025708
Provider Name (Legal Business Name): CARLIN EVANOFF PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 02/17/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 33RD ST STE 100
VANCOUVER WA
98663-2776
US

IV. Provider business mailing address

1363 W SPRUCE AVE
WASILLA AK
99654-5327
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-7550
  • Fax: 360-514-7553
Mailing address:
  • Phone: 907-376-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2301
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60747576
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number06-772-P
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: