=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497550628
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVANS FAMILY PSYCHIATRY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2025
-----------------------------------------------------
Last Update Date | 04/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2103 WINTERMERE POINTE DR
-----------------------------------------------------
City | WINTER GARDEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34787-5439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-326-7516
-----------------------------------------------------
Fax | 321-517-2999
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2103 WINTERMERE POINTE DR
-----------------------------------------------------
City | WINTER GARDEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34787-5439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 269-506-4555
-----------------------------------------------------
Fax | 321-517-2999
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE PROPRIETOR
-----------------------------------------------------
Name | MRS. ABIGAIL EVANS
-----------------------------------------------------
Credential | APRN, PMHNP, FNP
-----------------------------------------------------
Telephone | 269-506-4555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------