Provider Demographics
NPI:1720720642
Name:EVANS, ESSYNCE Y'STACIA JR
Entity type:Individual
Prefix:MS
First Name:ESSYNCE
Middle Name:Y'STACIA
Last Name:EVANS
Suffix:JR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 PRESERVE CT APT 308
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-3084
Mailing Address - Country:US
Mailing Address - Phone:470-872-7508
Mailing Address - Fax:
Practice Address - Street 1:4940 NORTHDALE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-1075
Practice Address - Country:US
Practice Address - Phone:813-485-8444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician