Provider Demographics
NPI:1396387825
Name:PEARCE, EBONI (NP)
Entity Type:Individual
Prefix:
First Name:EBONI
Middle Name:
Last Name:PEARCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 GREENBRIAR DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91915-1128
Mailing Address - Country:US
Mailing Address - Phone:619-438-5175
Mailing Address - Fax:
Practice Address - Street 1:502 EUCLID AVE STE 103
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2982
Practice Address - Country:US
Practice Address - Phone:619-470-4107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011995363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care