Provider Demographics
NPI:1578363388
Name:EVANS, TINIKKI SHUNTA
Entity type:Individual
Prefix:
First Name:TINIKKI
Middle Name:SHUNTA
Last Name:EVANS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 MEDICAL LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1116
Mailing Address - Country:US
Mailing Address - Phone:239-334-6161
Mailing Address - Fax:232-334-1339
Practice Address - Street 1:1650 MEDICAL LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1116
Practice Address - Country:US
Practice Address - Phone:239-334-6161
Practice Address - Fax:232-334-1339
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty