Healthcare Provider Details

I. General information

NPI: 1104207034
Provider Name (Legal Business Name): EBONY HOLLINS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 PHILOSOPHERS TER
CHESTERTOWN MD
21620-1612
US

IV. Provider business mailing address

126 PHILOSOPHERS TER
CHESTERTOWN MD
21620-1612
US

V. Phone/Fax

Practice location:
  • Phone: 443-215-5353
  • Fax: 833-615-2165
Mailing address:
  • Phone: 443-215-5353
  • Fax: 833-615-2165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346732
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC004640
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number254126
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number671463
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: