Provider Demographics
NPI:1356856363
Name:WARE, EBONY DENISE (RN)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:DENISE
Last Name:WARE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9313 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-8655
Mailing Address - Country:US
Mailing Address - Phone:863-221-5487
Mailing Address - Fax:
Practice Address - Street 1:9313 N 16TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-8655
Practice Address - Country:US
Practice Address - Phone:863-221-5487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9431535163W00000X, 163WW0000X, 163WH0200X
GARN256530163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WW0000XNursing Service ProvidersRegistered NurseWound Care