Healthcare Provider Details

I. General information

NPI: 1023470143
Provider Name (Legal Business Name): EBONY L REED LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12976 MANDARA LN
VENICE FL
34292-3827
US

IV. Provider business mailing address

86 SNEDEKER ST
PORT CHARLOTTE FL
33954-2326
US

V. Phone/Fax

Practice location:
  • Phone: 941-932-1104
  • Fax:
Mailing address:
  • Phone: 941-889-8497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5237001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: