Healthcare Provider Details

I. General information

NPI: 1568233757
Provider Name (Legal Business Name): EBONY TELFER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 HERON BAY RD
JACKSONVILLE FL
32218-3595
US

IV. Provider business mailing address

3834 OSWEGO AVE
WEST PALM BEACH FL
33409-4824
US

V. Phone/Fax

Practice location:
  • Phone: 904-470-6900
  • Fax:
Mailing address:
  • Phone: 561-506-6713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11029003
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: