Provider Demographics
NPI:1487395240
Name:DILLON, EVAN LELAND (FNP-C)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:LELAND
Last Name:DILLON
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 VINE ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-1100
Mailing Address - Country:US
Mailing Address - Phone:888-852-2567
Mailing Address - Fax:
Practice Address - Street 1:2449 OLD FORT PKWY
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-4162
Practice Address - Country:US
Practice Address - Phone:615-225-0140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0030990363LF0000X
TN39331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0030990OtherAPRN FNP
OH453682OtherRN