Provider Demographics
NPI:1083141626
Name:BLACKWOOD, EBONEE MONIQUE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:EBONEE
Middle Name:MONIQUE
Last Name:BLACKWOOD
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11301 OKEECHOBEE BLVD STE 5A
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8719
Mailing Address - Country:US
Mailing Address - Phone:561-729-5877
Mailing Address - Fax:
Practice Address - Street 1:11301 OKEECHOBEE BLVD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8719
Practice Address - Country:US
Practice Address - Phone:561-283-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-14
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9221157363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily