Provider Demographics
NPI:1699067348
Name:EVANS, ROBERT FRANK (MED,LIC SCH PSY RET)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:FRANK
Last Name:EVANS
Suffix:
Gender:M
Credentials:MED,LIC SCH PSY RET
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 FINCANNON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-1517
Mailing Address - Country:US
Mailing Address - Phone:904-743-1885
Mailing Address - Fax:904-743-1885
Practice Address - Street 1:6505 FINCANNON RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-1517
Practice Address - Country:US
Practice Address - Phone:904-743-1885
Practice Address - Fax:904-743-1885
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSY290 RETIRED103TS0200X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No174400000XOther Service ProvidersSpecialist