MEDICARE: AMY EBBITT CNP

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	363LF0000X	Family Nurse Practitioner	10139	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	NP10139	OTHER	OH	LICENSE

General Provider Information

NPI Number	:	1902056823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY EBBITT CNP

Provider Business Mailing Address
First Line	:	2609 QUEENSTON RD
Second Line	:
City	:	CLEVELAND HTS
State	:	OH
Zip	:	44118-4319
Country	:	US
Telephone Number	:	216-321-9847
Fax Number	:

Provider Business Practice Location Address
First Line	:	6412 FRANKLIN BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-3153
Country	:	US
Telephone Number	:	216-281-0872
Fax Number	:	216-281-9721

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2008
Last Update Date	:	05/27/2014

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Directions to “ AMY EBBITT CNP” Practice Location

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