Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH21944 | FL |
NPI | 1053859405 |
---|---|
Provider Name | Catina Evans |
First Address | Palmetto, FL 34221-3800 |
Second Address | Bradenton, FL 34208-5526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2017 |
Last Update Date | 06/02/2017 |