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General NPI Number Information
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NPI Number | 1568063873
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Entity Type | Individual
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Provider Name | LATASHA EVANS NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 6232 MARKET ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-2922
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Country | US
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Telephone | 215-444-7672
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 746722
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City | ATLANTA
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State | GA
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Zip | 30374-6722
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Country | US
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Telephone | 127-339-7303
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | SP022724
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License Number State | PA
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