Individual
EVAN MIKELL INCINELLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610
(352) 265-0111
Mailing address
PO BOX 100108, GAINESVILLE, FL 32610-0108
(352) 273-5670
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA9112310
FL
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104303800
—
FL
Enumeration date
05/08/2019
Last updated
01/24/2020
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