Provider Demographics
NPI:1659708485
Name:OLTON, EBONY PATRICE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:PATRICE
Last Name:OLTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11138 GOLDENROD FERN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-2230
Mailing Address - Country:US
Mailing Address - Phone:813-312-4413
Mailing Address - Fax:
Practice Address - Street 1:11138 GOLDENROD FERN DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-2230
Practice Address - Country:US
Practice Address - Phone:813-312-4413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-11
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9222592163W00000X
FLARNP 9222592363LA2200X
FLARNP9222592363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health