Provider Demographics
NPI:1659797645
Name:MAYNARD, EBONY L (ARPN)
Entity Type:Individual
Prefix:
First Name:EBONY
Middle Name:L
Last Name:MAYNARD
Suffix:
Gender:F
Credentials:ARPN
Other - Prefix:
Other - First Name:EBONY
Other - Middle Name:
Other - Last Name:MAYNARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:1877 FORTUNE RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4428
Mailing Address - Country:US
Mailing Address - Phone:407-943-8600
Mailing Address - Fax:833-464-3651
Practice Address - Street 1:1507 BILL BECK BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-9516
Practice Address - Country:US
Practice Address - Phone:407-943-8600
Practice Address - Fax:833-464-3651
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11017985363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner