Provider Demographics
NPI:1306950845
Name:MENDIOLA, EVANGELINA (ARNP)
Entity type:Individual
Prefix:MS
First Name:EVANGELINA
Middle Name:
Last Name:MENDIOLA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 800
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3920
Mailing Address - Country:US
Mailing Address - Phone:954-486-8020
Mailing Address - Fax:954-486-8983
Practice Address - Street 1:4400 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5862
Practice Address - Country:US
Practice Address - Phone:954-486-8020
Practice Address - Fax:954-486-8983
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2504712363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL304835700Medicaid