Active NPI
Nick R. Evangelista, PA
- Physician Assistant
- Savannah, GA
National Provider Identifier
1770535254
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 004375
- Practice address
- 210 E Derenne Ave
Savannah, GA 31405-6736 - Phone
- (912) 644-5300
- Fax
- (912) 644-5260
- NPI assigned
- May 16, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 004375 | GA | Primary |
Addresses
Primary practice location
210 E Derenne Ave
Savannah, GA 31405-6736
Mailing address
210 E Derenne Ave
Savannah, GA 31405-6736
Phone (912) 644-5300
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 706 | SC | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1261094400000",
"number": "1770535254",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "210 E DERENNE AVE",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314056736",
"telephone_number": "912-644-5300",
"fax_number": "912-644-5260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 E DERENNE AVE",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314056736",
"telephone_number": "912-644-5300",
"fax_number": "912-644-5260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANGELISTA",
"first_name": "NICK",
"middle_name": "R.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-16",
"last_updated": "2009-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "004375",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Savannah, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.