Provider Demographics
NPI:1124268180
Name:TOMYCZ, EVANN L (PA-C)
Entity type:Individual
Prefix:
First Name:EVANN
Middle Name:L
Last Name:TOMYCZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2584
Mailing Address - Country:US
Mailing Address - Phone:412-692-5090
Mailing Address - Fax:412-692-5921
Practice Address - Street 1:3705 5TH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2584
Practice Address - Country:US
Practice Address - Phone:412-692-5090
Practice Address - Fax:412-692-5921
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053063363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant