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General NPI Number Information
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NPI Number | 1235487000
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Entity Type | Individual
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Provider Name | EVELLAR MARISSA MCALLISTER ARNP
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Gender | Female
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Dates
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Enumeration Date | 08/27/2012
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 1064 N BROADWAY AVE
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City | BARTOW
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State | FL
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Zip | 33830
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Country | US
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Telephone | 863-519-9797
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Fax | 863-533-8723
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Provider Business Mailing Address
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Address Line | 1064 N BROADWAY AVE
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City | BARTOW
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State | FL
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Zip | 33830
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Country | US
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Telephone | 863-519-9797
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Fax | 863-533-8723
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | ARNP9275053
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License Number State | FL
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