Provider Demographics
NPI:1194132233
Name:BREEDLOVE, EVIE LYN (NP-C)
Entity type:Individual
Prefix:
First Name:EVIE
Middle Name:LYN
Last Name:BREEDLOVE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 PIPER BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1433
Mailing Address - Country:US
Mailing Address - Phone:239-514-2005
Mailing Address - Fax:239-593-0067
Practice Address - Street 1:1217 PIPER BLVD
Practice Address - Street 2:STE 101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1433
Practice Address - Country:US
Practice Address - Phone:239-514-2005
Practice Address - Fax:239-593-0067
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-21
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704276952363LA2200X
FLAPRN9388499363LP0808X
FL9388499363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health