Healthcare Provider Details

I. General information

NPI: 1629591938
Provider Name (Legal Business Name): EBONY T L HARVEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 PALO VERDE AVE STE 201
LONG BEACH CA
90808-4132
US

IV. Provider business mailing address

1601 N SEPULVEDA BLVD # 133
MANHATTAN BEACH CA
90266-5111
US

V. Phone/Fax

Practice location:
  • Phone: 562-542-3600
  • Fax:
Mailing address:
  • Phone: 919-935-6808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029942
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number207097
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: