Provider Demographics
NPI:1427760800
Name:EVOLVE MEDICAL LLC
Entity type:Organization
Organization Name:EVOLVE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAYE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:850-207-9086
Mailing Address - Street 1:1716 DONEGAL DR
Mailing Address - Street 2:
Mailing Address - City:CANTONMENT
Mailing Address - State:FL
Mailing Address - Zip Code:32533-8997
Mailing Address - Country:US
Mailing Address - Phone:850-207-9086
Mailing Address - Fax:
Practice Address - Street 1:22 N TARRAGONA ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-6063
Practice Address - Country:US
Practice Address - Phone:850-292-6623
Practice Address - Fax:850-366-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty