Healthcare Provider Details

I. General information

NPI: 1083353023
Provider Name (Legal Business Name): EBONIE BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2022
Last Update Date: 05/28/2022
Certification Date: 05/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 SE 8TH ST
GAINESVILLE FL
32601-8037
US

IV. Provider business mailing address

959 SE 8TH ST
GAINESVILLE FL
32601-8037
US

V. Phone/Fax

Practice location:
  • Phone: 912-980-2531
  • Fax:
Mailing address:
  • Phone: 912-980-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: