Provider Demographics
NPI:1386425437
Name:EVANS, TAKIA CHANTELL (RN, CRNP)
Entity type:Individual
Prefix:MRS
First Name:TAKIA
Middle Name:CHANTELL
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN, CRNP
Other - Prefix:MS
Other - First Name:TAKIA
Other - Middle Name:CHANTELL
Other - Last Name:KEARSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1417 OLD MILL LN
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1014
Mailing Address - Country:US
Mailing Address - Phone:215-279-2383
Mailing Address - Fax:
Practice Address - Street 1:1417 OLD MILL LN
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-1014
Practice Address - Country:US
Practice Address - Phone:215-279-2383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-12
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028347363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health