Healthcare Provider Details

I. General information

NPI: 1972417145
Provider Name (Legal Business Name): EBENEZER PRIMARY MEDICAL CARE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 MARION OAKS BLVD
OCALA FL
34473-6216
US

IV. Provider business mailing address

2592 SW 156TH PL
OCALA FL
34473-3493
US

V. Phone/Fax

Practice location:
  • Phone: 352-203-5122
  • Fax: 352-203-4355
Mailing address:
  • Phone: 352-203-5122
  • Fax: 352-203-4355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: ROLLA PIERRE
Title or Position: OWNER
Credential:
Phone: 352-203-5122