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2927 Pearson James Place Lutz FL 33559 | |
| (813) 428-5295 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2927 Pearson James Place, Lutz, Florida |
| Authorized Official Name and Position | Erica R Evans (CO-OWNER) |
| Authorized Official Contact | 4043702158 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 47475 Tampa FL 33646-0113 Ph: (404) 370-2158 | 2927 Pearson James Place Lutz FL 33559 Ph: (813) 428-5295 |
| NPI Number | 1306685003 |
|---|---|
| Provider Enumeration Date | 05/22/2024 |
| Last Update Date | 01/02/2025 |
| Certification Date | 01/02/2025 |
| Medicare PECOS PAC ID | 8921531930 |
|---|---|
| Medicare Enrollment ID | O20241030000180 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306685003 | NPI | - | NPPES |
| Provider Name | Erica Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801204193 PECOS PAC ID: 5698097822 Enrollment ID: I20201111000667 |
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