Active NPI
Evangela Dillard
- Community Based Hospice Care Agency
- Saint Petersburg, FL
National Provider Identifier
1275049561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- License
- 17438
- Practice address
- 10800 Brighton Bay Blvd NE Apt 7308
Saint Petersburg, FL 33716-3496 - Phone
- (727) 564-7769
- Fax
- (727) 800-5144
- NPI assigned
- Dec 21, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 17438 | FL | Primary |
Addresses
Primary practice location
10800 Brighton Bay Blvd NE Apt 7308
Saint Petersburg, FL 33716-3496
Mailing address
10800 Brighton Bay Blvd NE Apt 7308
Saint Petersburg, FL 33716-3496
Phone (727) 564-7769
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 80-0871218 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17438 | FL | MD | Community Based Hospice Care Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1513814400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1513814400000",
"number": "1275049561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10800 BRIGHTON BAY BLVD NE APT 7308",
"city": "SAINT PETERSBURG",
"state": "FL",
"postal_code": "337163496",
"telephone_number": "727-564-7769",
"fax_number": "727-800-5144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10800 BRIGHTON BAY BLVD NE APT 7308",
"city": "SAINT PETERSBURG",
"state": "FL",
"postal_code": "337163496",
"telephone_number": "727-564-7769",
"fax_number": "727-800-5144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DILLARD",
"first_name": "EVANGELA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-12-21",
"last_updated": "2017-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "FL",
"license": "17438",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "80-0871218",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Saint Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.