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General NPI Number Information
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NPI Number | 1972417145
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Entity Type | Organization
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Legal Business Name | EBENEZER PRIMARY MEDICAL CARE CLINIC LLC
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 166 MARION OAKS BLVD
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City | OCALA
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State | FL
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Zip | 34473-6216
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Country | US
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Telephone | 352-203-5122
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Fax | 352-203-4355
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Provider Business Mailing Address
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Address Line | 2592 SW 156TH PL
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City | OCALA
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State | FL
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Zip | 34473-3493
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Country | US
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Telephone | 352-203-5122
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Fax | 352-203-4355
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Authorized Official
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Title or Position | OWNER
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Name | ROLLA PIERRE
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Credential |
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Telephone | 352-203-5122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | NULL
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