Healthcare Provider Details

I. General information

NPI: 1770841561
Provider Name (Legal Business Name): EBELECHUKWU CHRIS NNOLI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2012
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14710 BRUCE B DOWNS BLVD
TAMPA FL
33613-2800
US

IV. Provider business mailing address

4439 STATE ROUTE 159 STE 120
CHILLICOTHEE OH
45601-8207
US

V. Phone/Fax

Practice location:
  • Phone: 813-738-6691
  • Fax: 813-816-0327
Mailing address:
  • Phone: 740-779-7201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.128704
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number63227
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME168693
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: