MEDICARE: EBANKS MEDICAL PRIMARY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1245094168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EBANKS MEDICAL PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	6209 W ROBINSON ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-1361
Country	:	US
Telephone Number	:	407-376-3375
Fax Number	:

Provider Business Practice Location Address
First Line	:	6209 W ROBINSON ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-1361
Country	:	US
Telephone Number	:	407-376-3375
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MRS. SHARON JENNIFER EBANKS
Credential	:	APRN
Telephone Number	:	407-376-3375

Provider Enumeration Date	:	02/12/2024
Last Update Date	:	02/12/2024

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