Individual
TERRENCE EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12630 NW 38TH AVE, REDDICK, FL 32686-4067
(352) 361-2968
Mailing address
12630 NW 38TH AVE, REDDICK, FL 32686-4067
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
01/29/2019
Last updated
01/29/2019
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