MEDICARE: MRS. NICOL SHANTEL EBANKS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		FL

General Provider Information

NPI Number	:	1467306217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICOL SHANTEL EBANKS FNP-C

Provider Business Mailing Address
First Line	:	9410 CHELSEA DR
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-3875
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2171 W ORANGE GROVE RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85741-3118
Country	:	US
Telephone Number	:	520-297-3907
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2026
Last Update Date	:	02/26/2026

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