Healthcare Provider Details

I. General information

NPI: 1851281257
Provider Name (Legal Business Name): AURIEL JENISSA EBY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21750 SUITE B FL-54
LUTZ FL
33549
US

IV. Provider business mailing address

21750 SUITE B FL-54
LUTZ FL
33549
US

V. Phone/Fax

Practice location:
  • Phone: 813-609-0909
  • Fax:
Mailing address:
  • Phone: 813-609-0909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11040625
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: