Provider Demographics
NPI:1871958330
Name:EVANS, CHRISTINA NICOLE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 POPLAR ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3336
Mailing Address - Country:US
Mailing Address - Phone:478-746-0097
Mailing Address - Fax:478-742-4051
Practice Address - Street 1:446 POPLAR ST
Practice Address - Street 2:SUITE B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3336
Practice Address - Country:US
Practice Address - Phone:478-746-0097
Practice Address - Fax:478-742-4051
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA170143363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily