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General NPI Number Information
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NPI Number | 1598636227
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Entity Type | Organization
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Legal Business Name | EVERGREEN HEALTHCARE COOPERATION PLLC
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Dates
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Enumeration Date | 09/16/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 400 N TAMPA ST STE 1550
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City | TAMPA
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State | FL
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Zip | 33602-4737
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Country | US
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Telephone | 917-428-8463
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Fax | 804-415-4040
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Provider Business Mailing Address
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Address Line | 400 N TAMPA ST STE 1550
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City | TAMPA
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State | FL
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Zip | 33602-4737
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Country | US
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Telephone |
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Fax | 804-415-4040
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Authorized Official
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Title or Position | CEO
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Name | DR. FREMLIN DEKYI JR.
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Credential | MD
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Telephone | 917-428-8463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085U0001X
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Taxonomy Name | Diagnostic Ultrasound Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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