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General NPI Number Information
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NPI Number | 1134765886
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Entity Type | Individual
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Provider Name | EVA MARIE BLACK FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/18/2019
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 376 COMMERCE AVE
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City | CARROLLTON
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State | AL
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Zip | 35447-2253
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Country | US
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Telephone | 205-614-6228
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Fax | 205-367-1612
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Provider Business Mailing Address
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Address Line | 91 PHOENIX AVE
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City | CARROLLTON
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State | AL
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Zip | 35447-2351
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Country | US
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Telephone | 662-549-4050
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 901756
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1-168015
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License Number State | AL
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