MEDICARE: ANDREW DAVID EVANS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9113612	FL

General Provider Information

NPI Number	:	1992397194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW DAVID EVANS PA-C

Provider Business Mailing Address
First Line	:	555 DR MARTIN LUTHER KING JR ST S UNIT 229
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33705-1805
Country	:	US
Telephone Number	:	727-539-9777
Fax Number	:

Provider Business Practice Location Address
First Line	:	5033 W LAUREL ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-3855
Country	:	US
Telephone Number	:	813-922-8939
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	02/09/2021

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