Provider Demographics
NPI:1487077269
Name:GENNARO, EVANGELINE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:EVANGELINE
Middle Name:
Last Name:GENNARO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16314 SAPPHIRE DR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3120
Mailing Address - Country:US
Mailing Address - Phone:954-349-7826
Mailing Address - Fax:954-349-7826
Practice Address - Street 1:10098 W MCNAB RD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1895
Practice Address - Country:US
Practice Address - Phone:954-724-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1100572363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner