Provider Demographics
NPI:1962000265
Name:WRIGHT, EBONY (RN)
Entity Type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:
Last Name:WRIGHT
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 1:12000 4TH ST N APT 24
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1709
Mailing Address - Country:US
Mailing Address - Phone:513-250-0281
Mailing Address - Fax:
Practice Address - Street 1:12000 4TH ST N APT 24
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1709
Practice Address - Country:US
Practice Address - Phone:513-250-0281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9480908163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse